Acute Telogen Effluvium Research Articles

Assurance versus frustration: a retrospective single-center analysis of female patients with acute telogen effluvium

Assurance versus frustration: a retrospective single-center analysis of female patients with acute telogen effluvium

Amino Acids Oral Treatment for the Amelioration of Skin, Hair, and Nails Conditions: An Open-Label Study

This study aimed at investigating the effect of a food supplement in ameliorating the skin, hair, and nails conditions. An open-label study on 21 women with mild-to-moderate aging all over the face (including wrinkles/fine lines, loss of skin firmness/elasticity, and normal to dry skin), acute telogen effluvium, and brittle/fragile nails was conducted. Skin (moisturization, elasticity, profilometry, and skin thickness), hair (pull test and phototricogram), and nails (clinical analysis of nail plate status) parameters were measured at baseline, and after 28 and 84 days of intake. The clinical analysis carried out by a board-certified dermatologist and the self-evaluation integrated the instrumental measurements. After 28 (D28) and 84 (D84) days of product intake the skin moisturization (superficial moisturization: +6.0% at D28 and +9.2% at D84; deep moisturization: +4.2% at D28 and +7.6 at D84), elasticity (R0 parameter: -11.5% at D28 and -19.3% at D84; R2 parameter: +7.8% at D28 and +11.9 at D84), profilometry (wrinkle depth: -9.5% at D28 and -14.5% at D84; skin smoothness: -4.9% at D28 and -7.7% at D84) and thickness (+0.11 mm at D28 and +0.24 mm at D84) were improved. At D84 the density of telogen hair was reduced by 9.5%; while at day 28 pull test was not indicative for telogen effluvium. The nail status was improved in most of the enrolled subjects. The instrumental measured effects were perceived by both the dermatologist and the enrolled subjects. Our results highlight the test product efficacy in improving the skin, hair, and nails conditions.

Skin manifestations and biophysical changes following weight reduction induced by bariatric surgery: A 2-year prospective study.

Skin manifestations and biophysical changes are observed in patients with morbid obesity. However, reports of changes after significant weight loss, particularly through post-bariatric surgery (BaS), are limited. The aim of this 2-year prospective study was to evaluate the prevalence of skin signs and their changes in patients with morbid obesity who underwent BaS. Thirty-one patients were recruited for the study, with a mean age of 38.35 (SD 10.61) years and a male preponderance (male = 19 [61.29%], female = 12 [38.71%]). Patients were scheduled for multiple visits at months 0, 3, 6, 12, 18, and 24 post-BaS. Each subject had a thorough skin examination, biophysical measurements, and laboratory tests at each visit. Striae, acanthosis nigricans (AN), and plantar hyperkeratosis were the most common skin findings (n = 30 [96.77%], 29 [93.55%], 29 [93.55%], respectively). BaS provided improvements in many skin manifestations, namely striae, AN, acrochordons, plantar hyperkeratosis, hirsutism, lymphedema, pruritus, acne, finger pebbles, and chronic venous insufficiency with varied cumulative rates of improvements. However, acute telogen effluvium was observed in 17 (54.84%) patients. Regarding skin biophysical properties, transepidermal water loss, skin hydration, and pH did not change, while sebum production on the face significantly decreased at months 3 and 6, and elasticity decreased at months 6 and 24. In conclusion, weight reduction by BaS provided improvements in various skin signs, although telogen effluvium was a common sequelae.

Diffuse Alopecia: Clinical, Trichoscopic, Histopathological and Immunohistochemical Challenges in the Diagnosis

Abstract Background Diffuse alopecia is characterized by a general loss of hair with no patches of full baldness. In dermatology, diffuse hair loss, particularly in women, is a common complaint. Common illnesses such as telogen effluvium, androgenetic alopecia, and widespread alopecia areata can be difficult to distinguish. The clinical signs of these three types of alopecia may be identical. Aim of Work The current study aimed to study the clinical, trichoscopic findings, histopathological in patients with acute diffuse hair shedding: female pattern hair loss (FPHL), acute telogen effluvium (TE) and alopecia areata incognita (AAI). Immunohistochemistry analysis for CD3 was done for differentiation and detection of the prognostic values of these markers. Subjects and methods: The study included 40 patients with acute diffuse hair shedding within the last 6 months with the diagnoses of AAI, TE, FPHL. All patients were subjected to full history recording, general and local examination. Hair evaluation was performed through trichoscopic assessment and punch scalp biopsy that was analyzed by hematoxylin and eosin and immunohistochemical analysis for CD3. Results Trichoscopic assessment of studied patients revealed that hair diameter diversity was significantly presented in FPHL patients. Number of thin hairs in frontal area, number of hair units with one hair, and vellus hairs were significantly presented in FPHL and TE+ FPHL patients compared to TE patients. Short regrowing hair was significantly presented in TE patients and TE +FPHL patients compared to FPHL patients. Peripilar sign and empty hair follicles in frontal area were significantly presented in FPHL patients. Multiple upright regrowing hair in all areas was significantly presented in TE+ FPHL patients. Conclusion FPH and TE represents common types of hair loss disease, each with specific trichoscopic and histochemical findings.

Telogen effluvium and COVID-19: a cross-sectional study.

COVID-19 is a febrile infectious disease caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). This virus affects several organs, including the skin. Acute telogen effluvium (TE) is a non-scarring hair loss characterized by diffuse hair shedding that begins three months after a stressful event and can last up to six months. COVID-19 infection is one of these potential stressors. Recently, there has been a reported link between increased scalp hair shedding and post-infection patients during the COVID-19 outbreak. The present work aimed to study the possible effects of COVID-19 on hair and the relationship between COVID-19 and TE and to assess the level of awareness about TE in the Asir region of Saudi Arabia. A questionnaire-based cross-sectional study was conducted using a pre-validated questionnaire. The study involved 561 participants from the Asir region of Saudi Arabia. Eligible participants were individuals from the Asir region who were 20 years of age or older, had previously contracted COVID-19 and had no history of TE before infection. All statistical methods used were two-tailed with an alpha level of 0.05, considering significance if the p-value was lower than or equal to 0.05. A total of 1,000 eligible participants completed the study questionnaire. The mean age was 32.5 ± 13.9 years, and 494 (88.1%) participants were females. In addition, 558 (99.5%) of the study participants had received the COVID-19 vaccine. A total of 411 (73.3%) participants experienced an increase in hair loss after COVID-19 infection, and 171 (30.5%) began suffering from pain when combing their hair. In addition, 182 participants (32.4%) had a family history of TE. Only 109 (10.9%) participants had a good awareness level about TE, while 452 (80.6%) had an overall poor awareness level. There was a significant relationship between the level of awareness and age, where 23.9% of the participants aged 20-29 years had a good level of awareness vs. 16.1% of others aged 40 years or older (p = 0.041). Moreover, 26.9% of participants with a family history of TE had a good awareness of TE, vs. 15.8% of those with no family history of TE (p = 0.002). In addition, significant correlations were found between increased hair loss post-COVID-19 infection and female gender (77.3% vs. 43.3%; p = 0.001) as well as suffering from pain when combing hair (86.5% vs. 65.5%; p = 0.001). In our study, the incidence of TE was highly related to COVID-19 infections among both sexes. However, the incidence was greater among the female population. The awareness level toward post-COVID-19 TE was poor among most of the participants in our study.

Review of the post-COVID-19 syndrome associated to acute telogen effluvium

Coronavirus disease 2019 (COVID-19) has impacted our society in numerous ways. So far (November 2022) around 640 million SARS-CoV-2 infections have been confirmed worldwide. It is known that this disease has a main affection at the cardiopulmonary level, however, it affects almost all the organs and systems of the body, including the skin. Post-COVID-19 syndrome occurs in some patients, leaving significant sequelae that impact their quality of life. Among the most common sequelae are: cough, dyspnea, chronic fatigue, hyposmia and dysosmia. In addition to these, other sequelae not related to respiratory syndrome have been reported, such as hair loss, which has been observed in around 20% of post-COVID-19 patients, this could be attributable to acute telogen effluvium (TE). To date, no study has been conducted to determine the relationship of ET in those who have had COVID-19. Acute ET is defined as diffuse, non-scarring hair loss, usually self-limited, lasting for about 6 months. Within its etiology, severe systemic febrile illness, pregnancy, restrictive diets, severe stress and various drugs have been described. It seriously affects the quality of life of patients and is often associated with loss of confidence and low self-esteem.

The Association Between Hair Loss and COVID-19: The Impact of Hair Loss After COVID-19 Infection on the Quality of Life Among Residents in Saudi Arabia.

Background Coronavirus disease 2019 (COVID-19) is an infectious disease that is associated with many health conditions, including, but not limited to, dermatological diseases. Some patients suffer from hair loss after becoming infected with severe acute respiratory syndrome coronavirus 2. Acute telogen effluvium (TE) is a non-scarring hair loss that usually occurs three months after a stressful event and can last up to six months, and it can be associated with post-COVID-19 infections. This study aims to explore the prevalence of hair loss among recovered COVID-19 patients in Saudi Arabia and determine the contributing factors. Furthermore, we aimed to measure the impact of hair loss after COVID-19 on their quality of life. Methodology An observational, cross-sectional study was conducted from Septemberto December 2021 in Saudi Arabia. A questionnaire was used to assess hair loss after being infected with COVID-19. Furthermore, quality of life was assessed using the Dermatology Life Quality Index (DLQI) questionnaire.Participants were recruited by sharing the questionnaire on social media platforms (Twitter, Telegram, and WhatsApp). The data were analyzed using SPSS version 23 (IBM Corp., Armonk, NY, USA). Frequency and percentages were used to display categorical variables, while minimum, maximum, mean, and standard deviation were used to present continuous variables. The categorical variables were compared using a chi-square test, and the statistical significance cut-off was set at p < 0.05. Results A total of 806 participants were included in the study, of whom 52.7% experienced hair loss after COVID-19 infection. Age, gender, high temperature during, and the presence of hair loss prior to infection were significantly associated with the incidence of TE. The severity of life affection based on DLQI showed that 91.4% of the participants did not have severe life affection, while 8.6% had their lives severely affected. Conclusions This study revealed subjective hair loss that was significantly associated with high temperature, being female, and having a history of previous hair loss. Further studies using objective assessments are suggested for reaching more precise conclusions.

PATHOGENESIS, DIAGNOSIS, AND MANAGEMENT OF TELOGEN

Telogen effluvium (TE) is one of the most common causes of diffuse nonscarring hair loss. A number of factors have been implicated in the causation of TE, however, clear evidence in their support is lacking. The role of stress as a causative factor as well as the result of hair loss needs to be adequately understood. Telogen effluvium can occur in people of any age, gender, and racial background. Telogen effluvium can occur in both men and women, although women have a greater tendency to experience this condition due to postpartum hormonal changes and also women experience hair loss more often than men. In children, TE was reported to be responsible for only a minority of cases with hair loss (2.7%). The symptom of acute and chronic TE is increased hair loss. Usually, the hair will fall out at an increasing rate. The remaining hair will feel less dense. Acute telogen effluvium can heal itself by eliminating the triggering factor which is done by providing education to the patient while treatment for chronic TE can be done by giving Minoxidil.&#x0D; &#x0D; Keywords: Telogen effluvium acute and chronic; hair loss; minoxidil.

Post-SARS-CoV-2 Acute Telogen Effluvium: An Expected Complication.

Post-SARS-CoV-2 telogen effluvium has been described in case reports of COVID-19 patients. We evaluated the prevalence of post-SARS-CoV-2 telogen effluvium in patients from a single medical center, exploring any causal links with the infection. Our hospital-based, cross-sectional study was conducted with patient participants discharged with a diagnosis of SARS-CoV-2 pneumonia from 1 March to 4 April 2020. All patients were evaluated by the same senior dermatologist; a clinical/dermatoscopic evaluation was performed. Alopecia was assessed in 31.3% of patients, with a significant difference in sex (females 73%, males 26.7%). The average time detected from the onset of the first symptoms to alopecia was 68.43 days. Overall, there were no significant associations between alopecia and COVID-19-related features (length of hospitalization, virologic positivity, or duration of fever), treatment characteristics, or laboratory findings. In this paper, we report that post-infection acute telogen effluvium occurs in a significant number of COVID-19 patients. The burden of this condition may impair the quality of life, with a significant impact on individuals.

Covid Induced Telogen Effluvium (CITE): An Insight.

Hair loss is one of the most common post-covid symptoms observed during this severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Pro-inflammatory cytokines, direct viral effect on hair follicles, and microthrombi are thought to be the pathogenic factors considered. Information regarding time of onset and severity is similar to other infection-induced acute telogen effluvium. It is reasonable to think that the evolution and prognosis are similar, and therefore, even without any specific treatment, full recovery of lost hair is expected.

A systematic review of acute telogen effluvium, a harrowing post-COVID-19 manifestation.

This systematic review focuses on the clinical features, physical examination findings, outcomes, and underlying pathology of acute telogen effluvium (TE), a type of diffuse hair loss, occurring in coronavirus disease 2019 (COVID-19) recovered patients. MEDLINE/PubMed and Embase databases were queried till October 2021 to identify studies reporting acute TE occurring after COVID-19 recovery. Data were obtained from 19 studies, which included 465 patients who were diagnosed with acute TE. The median age of these patients was 44 years and 67.5% were females. The most common trichoscopic findings were decreased hair density, the presence of empty follicles, or short regrowing hair. The mean duration from COVID-19 symptom onset to the appearance of acute TE was 74 days, which is earlier than classic acute TE. Most patients recovered from hair loss, while a few patients had persistent hair fall. Our results highlight the need to consider the possibility of post-COVID-19 acute TE in patients presenting with hair fall, with a history of COVID-19 infection, in the context of COVID-19 pandemic. Despite being a self-limiting condition, hair loss post-COVID-19 is a stressful manifestation. Identifying COVID-19 infection as a potential cause of acute TE will help the clinicians counsel the patients, relieving them from undue stress.

Assessment of the effects of a hair lotion in women with acute telogen effluvium: a randomized controlled study.

Telogen effluvium is a hair loss disorder occurring about 3months after a triggering event. The acute form impairs quality of life, but spontaneous recovery usually begins 3-6months after identification and elimination of the cause, with complete recovery taking around 12months. To investigate the effectiveness and safety of a hair lotion containing creatine, acetyl tetrapeptide-2 and B vitamins for reducing hair loss in acute telogen effluvium. In this open, randomized, controlled study (NCT04652232), women with acute telogen effluvium from two clinical centres were randomly allocated to receive either the lotion and a mild shampoo (intervention group), or the mild shampoo alone (controls). Hair growth parameters and hair loss were measured from phototrichograms at weeks (W) 1, 4, 8 and 16, and through investigator assessments of standardized photographs at W1 and W16. The primary criterion was the change in anagen to telogen (A/T) ratio between W1 and W16. One hundred women (aged 19-50years) were included (intervention group, N=51; controls, N=49). Compared to baseline, the A/T ratio was higher at W16 in both groups and was significantly higher at both W4 and W8 in the intervention group, compared to only at W8 in controls. Significant decreases in telogen hair density were seen at all time points in the intervention group, compared to only at W16 in controls, and the between-group difference was significant at W8 (P=0.0465). A larger reduction in the total number of hairs shed was observed at W8 in the intervention group (P=0.0392). Investigator-assessed scores showed improvements in hair density for the intervention group. Global tolerance of the lotion was excellent. The lotion tested had a significant impact on hair loss in women with acute telogen effluvium and appeared to accelerate recovery from this condition.

Chronic telogen effluvium in women

Background Chronic telogen effluvium (CTE) is a form of diffuse hair loss in middle-aged women in whom telogen hair loss continues more than 6 months without obvious etiology. Disturbance in growth hair cycle may result in increased hairs in the telogen phase. Micronutrient deficiency, such as iron, zinc, and vitamin D, has been incriminated in acute telogen effluvium but its role in chronic phases is challenging. Objective To measure the levels of serum ferritin, zinc, and 25-hydroxy vitamin D (25OH vitamin D) in females with CTE and controls to verify their role in hair-loss pathogenesis. Patients and methods A case–control study was conducted on 166 female participants: 83 patients with CTE and 83 age-matched healthy controls. Blood samples were taken from all participants for evaluation of serum ferritin, zinc, and 25OH vitamin D levels. Ferritin and 25OH vitamin D levels were measured with chemiluminescence method and zinc level was measured with colorimetric method. The study was done during 6 months (autumn and winter). Results There was no significant difference in serum ferritin, zinc, and 25OH vitamin D levels in two groups. The median of ferritin level was suboptimal in both groups (≤40 μg/l). Interestingly, zinc and 25OH vitamin D levels in healthy participants were lower than patients with CTE, but with considering the significance level of 0.01, this difference was not significant. The frequency of suboptimal levels of ferritin, 25OH vitamin D, and zinc was not significantly different in two groups. Conclusion We found no significant difference in ferritin, 25OH vitamin D, and zinc levels in two groups, but the role of these micronutrients in CTE could not be ignored. It seems that suboptimal levels of ferritin and 25OH vitamin D in women are common and may have led this non significant difference.

COVID-19 infection is a major cause of acute telogen effluvium.

BackgroundAcute telogen effluvium is a non-scaring hair loss, usually occurs 3 months after the stressful event that causes hair shedding, and lasts up to 6 months. It can be associated with post COVID-19 infection.ObjectiveTo study the possible effects of COVID-19 on the hair growth cycle and the relationship between COVID-19 and acute telogen effluvium.Patients and methodsThis is an observational cross-sectional study that had been conducted during the period from September 2020 to March 2021 years. Thirty-nine patients with post COVID-19 hair loss are confirmed by polymerase chain reaction (PCR) or antibody testing. Hair pull test was carried out to confirm the diagnosis and severity of telogen effluvium.ResultsThirty-nine patients were evaluated; their ages ranged from 22 to 67 years with a mean and SD of 41.3 ± 11.6 years with 36 (92.3%) females and 3 (7.69%) males.All patients with a diagnosis of ATE were enrolled in this study and had a laboratory-confirmed diagnosis of prior SARS-CoV-2 infection; 15 (38.46%) patients reported mild symptoms, 24 (61.53%) patients presented with moderate disease, and no patient required hospitalization. They all experienced excessive hair loss within 2–3 months after infection. Pull tests were strongly positive (> 10–50% with a mean of 35% of pulled hair away from scalp).ConclusionCOVID-19 infection is now a frequent and a common cause of acute telogen effluvium. Hence, clinicians should be aware about the relation between this infection and this pattern of hair loss. Drugs that have been used for the treatment of COVID-19 were excluded as a cause of acute telogen effluvium.

Time of onset and duration of post-COVID-19 acute telogen effluvium

To the Editor: During the COVID-19 pandemic, cases of acute hair shedding following the infection have been reported. Telogen effluvium (TE), a self-limiting cause of diffuse hair shedding, typically occurs 2 to 3 months after a triggering event, such as febrile state, stress, drugs, or postpartum.1 We aimed to evaluate the onset and duration of acute TE post COVID-19.

The Significance of Serum Ferritin and vitamin D Levels in Females Patients with Chronic Telogen Effluvium

Back ground : Diffuse hair loss is a very common complaint usually occurs without inflammation or scarring.The loss affects hairs throughout the scalp in a more or less uniform pattern . That is characterized by theingress of a large number of hairs prematurely into telogen phase resulting in diffuse hair shedding at onetime often with an acute onset so named acute telogen effluvium .A chronic form with a more insidious onsetand a longer duration also exists called chronic telogen effluvium which primarily affects women betweenthe ages of 30 and 60 years and is a diagnosis of exclusion and can cause a great psychological impact onthe life of the affected person.Objective: Measurement the level of serum ferritin and the level of serum vitamin D In adult females withchronic telogen effluvium in order to validate their role in the process of hair loss .Patients&amp; Methods : This cross-sectional study was conducted at the outpatient Department of Dermatologyand Venereology in Al-kindy Teaching Hospital between March and November 2017.Sixty adult Female atage (12 to 52 years) with hair loss in the form of CTE otherwise they are healthy and sixty adult healthy withsame age-matched female with no hair loss were included in the study. Diagnosis was based upon clinicalexamination as well as hair pull test. Serum ferritin and vitamin D levels and Hemoglobin were determinedfor each participant .Results : Hair loss can have an emotional impact on patients leading to anxiety and frustration. Therefore,diagnosing the underlying etiology is necessary for the better management of the disorder The results of thisstudy suggest that the reduced hair density seen in CTE may possibly be associated with low serum levelsof ferritin and vitamin D. It is recommended that hemoglobin level measurement should not be solely reliedon in the assessment of hair loss, as it was not significantly different between patients with CTE and controlsas seen in our study.Conclusions: The female cases in this study had significantly low levels of serum ferritin and vitamin D thancontrols .Our study highlights the importance of serum ferritin and vitamin D evaluation in case of diffusehair fall.

Acute Telogen Effluvium in Patients Recently Infected with SARS-CoV-2

Introduction: The hair cycle is especially susceptible to endogenous and exogenous stimuli, including febrile states and emotional stress, which are a constant in this pandemic era. In this case series, we describe the clinical characteristics of patients recently diagnosed with SARS-CoV-2 infection who developed acute telogen effluvium.&#x0D; Material and Methods: We performed a registry of patients with laboratory-confirmed SARS-CoV-2 infection who developed acute telogen effluvium and actively sought medical care at the Hair Unit of Dermatology Center of CUF Descobertas Hospital, from March 2020 to October 2020. Patient demographics, the month of SARS-CoV-2 infection diagnosis, COVID-19 associated symptoms, latency of telogen effluvium, duration of hair loss, and associated scalp symptoms were recorded.&#x0D; Results: Twenty-seven patients recently diagnosed with SARS-CoV-2 infection presented with acute telogen effluvium. Of them, 5 (18.5%) patients mentioned trichodynia. The median time of latency of increased hair loss since SARS-CoV-2 infection diagnosis was 10 weeks. In a third of cases (n=9, 33.3%), hair loss occurred early (with a latency period of 3 weeks or less). The resolution of telogen effluvium was documented in 16 (59%) cases with a median duration of hair loss of 24.5 days. The most common symptoms of COVID-19 were fever (n=17, 63%), ageusia (n=8, 30%), cough (n=6, 22%), myalgia (n=5, 18.5%), anosmia (n=4, 15%), and thoracalgia (n=3, 11%). Four patients (15%) with SARS- -CoV-2 infection were asymptomatic for COVID-19.&#x0D; Discussion: Acute telogen effluvium corresponds to a delayed consequence of an abnormal shift in the hair cycle from anagen to telogen, which is responsible for premature hair shedding, occurring approximately two to three months after a triggering event. Viral illnesses and febrile states are known causes. Regarding SARS-CoV-2 infection, we hypothesize that viral cytopathic effects and inflammatory or immune responses may affect hair follicles and explain hair loss and trichodynia.&#x0D; Conclusion: Our case series presents the first comprehensive collection of patients with acute telogen effluvium following SARS-CoV-2 infection. Interestingly, in a third of our cases, telogen effluvium developed within the first 3 weeks of SARS-CoV-2 infection. Based on these data, we propose that this finding should be considered in COVID-19, especially at the convalescent phase.

Impact on Quality of Life among Females with Diffuse Hair Loss at a Tertiary Care Centre: A Cross-sectional Study

Introduction: There is an important link between hair and identity, especially for women. Although, hair loss is a benign problem, experience of alopecia or hair loss is psychologically damaging, causing intense emotional suffering and personal, social and work related problems. Aim: To assess the impact of diffuse hair loss on the Quality of Life (QoL) among females with the help of Dermatology Life Quality Index (DLQI). Materials and Methods: This was a hospital based cross- sectional study conducted over a period of one year from February 2019 to February 2020. All female patients more than 18 years with complaints of diffuse hair loss attending the Dermatology Outpatient Department (OPD) of Vinayaka Mission’s Kirupananda Variyar Medical College and Hospital, Tamil Nadu, India, were recruited and QoL was assessed in them using the DLQI scale. For statistical analysis, Analysis of variance (ANOVA) test was used to compare quantitative variables, while Fisher’s-exact test was used to analyse qualitative data. Post- hoc ANOVA was used to test the statistical significance within the groups and a p-value &lt;0.05 was considered statistically significant. Results: The study included 100 female patients with diffuse hair loss, out of which most commonly seen was Acute Telogen Effluvium (ATE) in 52 patients followed by Female Pattern Hair Loss (FPHL) in 30 patients and Chronic Telogen Effluvium (CTE) in 18 patients. Majority of the study subjects were in the age group of 18-39 years (64%). The mean age of the study population was 35.36±10.30 years. The mean duration of hair loss was 8.14±8.639 months. Majority (92%) of females had moderate to severe effect on the QoL. The mean DLQI was significantly higher in FPHL (8.77±1.83) and ATE (8.73±1.98) as compared to CTE (p-value=0.014). The mean DLQI was highest (8.70±2.253) in the younger age range of 18-29 years (p-value=0.027) and also in those with duration of hair loss more than one year (9±1.76) (p-value=0.0381). Conclusion: Diffuse hair loss in females has a moderate to severe impact on the QoL as assessed by the DLQI. There is a strong association seen between DLQI and age, duration of disease and type of hair loss.

Acute telogen effluvium associated with SARS-CoV-2 infection.

Acute telogen effluvium has been recognised as a dermatological sequela of COVID-19.

Sequential cyclic changes of hair roots revealed by dermoscopy demonstrate a progressive mechanism of diffuse alopecia areata over time.

Diffuse alopecia areata (DAA) often leads to a complete hair shedding within a few months. To explore features and mechanisms underlying DAA. Scalp and hair root dermoscopy were conducted on 23 DAA patients throughout the disease process, 20 patchy Alopecia areata patients, 23 acute telogen effluvium (ATE) patients and 10 normal controls. Histopathology was also evaluated. We found almost all hair roots were anagen in early stage DAA in 18 patients (18/23, 78.3%) within the first 4-8weeks after hair loss onset. Anagen effluvium (~4weeks) was followed by catagen (~4weeks) and then telogen/exogen (~8weeks) effluvium with overlap. Hair root and proximal hair shaft depigmentation was more prominent in later DAA disease stages. Black dots, exclamation mark hairs and inconsistent thickness of hair shafts were found more often in early than later DAA (Ps<0.01). Early DAA histopathology revealed more prominent inflammation and hair follicle regression than that observed in the later stages. Patchy alopecia areata patients showed mixed anagen, catagen and telogen hair roots while ATE patients showed increased exogen and mildly decreased hair root pigmentation. Sequential cyclic staging of shed hairs in DAA indicates the insult may be hair-cycle specific. We suggest that DAA is initially an anagen effluvium disease involving an intense inflammatory insult, later progressing to a brief catagen effluvium, and then to telogen effluvium with premature exogen, in later stages of DAA.