Abstract
Background: Chronic telogen effluvium (CTE) may be primary or secondary to various causes, including drug reaction, nutritional deficiency and female pattern hair loss (FPHL). Oral minoxidil stimulates hair growth, and topical minoxidil is used in the treatment of FPHL and male androgenetic alopecia. minoxidil has not been used to treat CTE. This study aimed to assess the treatment of CTE with once daily oral minoxidil. Methods: Women with a diagnosis of CTE based on >6 month history of increased telogen hair shedding, no visible mid frontal scalp hair loss (Sinclair stage 1) and no hair follicle miniaturization on scalp biopsy were treated with once daily oral minoxidil. Hair shedding scores (HSS) at baseline, 6 and 12 months were analysed using the Wilcoxon rank sum test for pair-wise comparisons. Results: Thirty-six women were treated with oral minoxidil (range, 0.25-2.5 mg) daily for 6 months. Mean age was 46.9 years (range 20-83), HSS at baseline was 5.64, and duration of diagnosis was 6.55 years (range 1-27). There was a reduction in mean HSS scores from baseline to 6 months of 1.7 (p<0.001) and baseline to 12 months of 2.58 (p<0.001). Five women who described trichodynia at baseline, noted improvement or resolution within 3 months. Mean change in blood pressure was minus 0.5 mmHg systolic and plus 2.1 mmHg diastolic. Two patients developed transient postural dizziness that resolved with continued treatment. One patient developed ankle oedema. Thirteen women developed facial hypertrichosis. For 6 patients this was mild and did not require treatment; 4 had waxing of their upper lip or forehead; 3 had laser hair removal. No patients developed any haematological abnormality. All 36 women completed 12 months of treatment. Conclusions: Once daily oral minoxidil appears to reduce hair shedding in CTE. Placebo controlled studies are recommended to further assess this response.
Highlights
Hair shedding severity can be scored using a visual analogue scale[1]
Long-term follow up studies of women with primary CTE9 and histomorphometric and immunohistochemical examination of scalp biopsies in patients with both female pattern hair loss (FPHL) and Chronic telogen effluvium (CTE) have confirmed that primary CTE is not a prodrome to AGA10
Our understanding of the pathogenesis of CTE and the mechanism of action of minoxidil on hair growth suggest it should work in CTE patients, and we have found that women with androgenetic alopecia (AGA) who are unresponsive to topical minoxidil often respond to oral minoxidil at our clinic
Summary
Hair shedding severity can be scored using a visual analogue scale[1]. For women with long hair, a shedding severity of 1, 2 or 3 is considered normal; severity 4 is borderline; while a shedding severity of 5 or 6 is excessive (Figure 1). Telogen effluvium is a non-scarring alopecia characterised by excessive shedding of telogen club hair diffusely from the scalp. It generally begins 8–12 weeks after a triggering event, such as pregnancy, major illness or complicated surgery, and resolves within 3–6 months. Chronic telogen effluvium (CTE) may be primary or secondary to various causes, including drug reaction, nutritional deficiency and female pattern hair loss (FPHL). This study aimed to assess the treatment of CTE with once daily oral minoxidil. Methods: Women with a diagnosis of CTE based on >6 month history of increased telogen hair shedding, no visible mid frontal scalp hair loss (Sinclair stage 1) and no hair follicle miniaturization on scalp biopsy were treated with once daily oral minoxidil. Placebo controlled studies are recommended to further assess this response
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