Follicular skin diseases
Hair problems case challenge 1
The first is a lady of 36, who is complaining that her hair has been falling out for the last month. “My hairbrush is full of hair and the shower drain is blocked”, she tells you. “Am I going to go completely bald?” she adds.
On examination she has no areas of baldness and shiny, healthy-looking hair. There is no scalp disease. You perform a gentle hair-pull test, tugging out about 5 loose hairs.
What are you looking for?
*! Ratio of anagen to telogen hairs
* Broken-off hair shafts
* Hair shaft abnormality
* Evidence for chemical poisoning
Explanation: The hair pull test is to confirm the presence of hair shedding and to determine the ratio of anagen to telogen hairs.
The majority of hairs in the patient described have white bulbs at one end.
Which stage of hair growth does this represent?
* Cut ends
Select plausible explanation for hair shedding from the following list:
# Allergy to hair dye
# Pregnancy two years ago
#! Telogen effluvium
#! Acute sinusitis 3 months earlier
Explanation: Hair shedding is most often due to telogen effluvium. This may occur two or three months after an event such as a fever, pregnancy or weight loss. Hair dye may cause contact allergic dermatitis but does not cause hair loss.
What is her chance of going completely bald from this episode?
Short answer: None. Telogen effluvium is followed by new hair growth and does not result in bald patches. Diffuse alopecia is sometimes due to alopecia areata, which may result in alopecia totalis (5%), but in this case the loose hairs fall out during the anagen phase and show a distorted hair shaft.
However, it is not always easy to tell the difference between telogen effluvium and diffuse alopecia areata, so sometimes it pays to be circumspect regarding prognosis.