Telogen Effluvium Research Articles

Role of oral minoxidil in the treatment of androgenetic alopecia

Patterned hair loss is the most common cause of alopecia, typically presenting with progressive thinning, miniaturization, and loss of hair at classical topography depending on the sex of the patient. In the 1970s, Minoxidil was used to treat severe refractory hypertension due to its vasodilator properties. It became popular after its coincidental finding on the promotion of hair growth and stimulation of new hair production. In 1988, the Food and Drug Administration approved topical minoxidil (TM) 2% for the treatment of male androgenetic alopecia and in 1992, for female pattern hair loss. It is also used as an off-label treatment for other hair loss conditions such as telogen effluvium and alopecia areata. However, there are frequent reports of TM-induced contact dermatitis and its reversible effect, which has reduced compliance in the patients and resulted in a poor outcome. Hence, they have studied using low-dose oral minoxidil (LDOM), which showed good efficacy and safety profile in the treatment of patterned hair loss along with avoidance of high-risk adverse cardiac effects that resulted due to doses used for hypertension. The added advantages of LDOM over topical formulation are good compliance, cost savings, effective in people with low hair follicle sulfotransferase activity, and the possibility of cotherapy with other topical or oral medications.

Role of zinc in chronic telogen effluvium in serum and hair of patients with alopecia.

To determine the levels of zinc in hair and serum samples of chronic telogen effluvium patients. The case-control study was conducted at the Dow University of Health Sciences, Karachi, from April 2017 to May 2018, and comprised diagnosed cases of chronic telogen effluvium in group A, and healthy controls matched for age and gender in group B. Hair pull test was done, and level of zinc in hair and serum samples was determined using atomic absorption spectrophotometer. Data was analysed using SPSS 21. Of the 100 subjects, 50(50%) were in group A; 28(56%) females ad 22(44%) males with mean age 27.46±4.98 years. There were 50(50%) subejcts in group B; 26(52%) males ad 24(48%) females with mean age 28.34±4.92 years (p>0.05). Significantly low levels of zinc were observed in serum as well as hair samples in group A compared to group B (p<0.05). A positive significant association was observed in the level of zinc in hair with their concentration in the serum of subjects in both the groups (r=0.310, p<0.05). Low levels of zinc in hair and serum were found to be associated with chronic telogen effluvium.

Analysis and clinical determinants of post-COVID-19 syndrome in the Lombardy region: evidence from a longitudinal cohort study

ObjectiveTo define macro symptoms of long COVID and to identify predictive factors, with the aim of preventing the development of the long COVID syndrome.DesignA single-centre longitudinal prospective cohort study conducted...

Comparison of Telogen Effluvium Incidence in Hospitalized and Outpatient Settings after Recovery from COVID-19.

Comparison of Telogen Effluvium Incidence in Hospitalized and Outpatient Settings after Recovery from COVID-19.

Is thyroid dysfunction a common cause of telogen effluvium?: A retrospective study.

Telogen effluvium (TE) is a common cause of hair loss characterized by excessive resting hair shedding. Thyroid dysfunction is one of the possible causes of TE. On the other hand, the link between thyroid disorder and TE is still being debated. The aim of this retrospective is to investigate the link between thyroid dysfunction and TE. This retrospective study included 500 female patients with TE who had thyroid function testing between January 2012 and December 2022. Patients were eligible if they had a confirmed TE diagnosis and thyroid function tests within 3 months of being diagnosed with TE. The thyroid function of the participants was classified as euthyroid, hypothyroidism, or hyperthyroidism. The severity of hair loss was determined using the severity of alopecia tool (SALT) score. The study included 500 TE females, 248 of whom were euthyroid, 150 had hypothyroidism, and 102 had hyperthyroidism. The hypothyroid group had a significantly higher mean SALT score than the other 2 groups. Furthermore, patients in the hypothyroid group had a higher proportion of severe hair loss. The mean SALT score did not differ significantly between groups with normal thyroid function and those with hyperthyroidism. A common cause of TE is thyroid dysfunction, particularly hypothyroidism. Patients with hypothyroidism have more severe hair loss than those with normal thyroid function or hyperthyroidism. To effectively identify and manage such cases, thyroid function testing should be included in the diagnostic workup of patients with TE.

Dissolvable microneedles loaded ginsenoside Rg3 liposome: a transdermal delivery approach for alopecia treatment.

The skin stratum corneum (SC) barrier function will interfere with the absorption of topical treatment and reduce the drug's therapeutic effect on alopecia. Microneedles (MNs) can penetrate the skin barrier and deliver drugs to the dermis. Furthermore, MNs can mechanically stimulate the skin, which promotes hair growth. Thus, we designed a green and dissolvable composite microneedle made of hyaluronic acid (HA) and Bletilla striata polysaccharide (BSP) to encapsulate cholesterol-free ginsenoside Rg3 liposomes (Rg3-LPs) to avoid cholesterol metabolism-producing testosterone to inhibit hair regeneration and minimize the effect of the SC barrier on liposomes absorption. HA and BSP can enhance the mechanical strength of Rg3-MNs to ensure the transport of liposomes to the hair follicle (HF) region while causing minimal skin irritation and guaranteeing cell compatibility. In addition, HA increased hair density and was more conducive to hair regeneration. In telogen effluvium (TE) and testosterone-induced androgenetic alopecia (AGA) animals, Rg3-MNs achieved comparable efficacy to minoxidil with low-frequency treatment and the quality of regenerated hair was higher. Furthermore, quantitative characterization and transcriptome sequencing results showed that Rg3-MNs promoted hair regeneration by promoting the expression of Wnt3a and Wnt10b genes, activating the Wnt/β-catenin pathway. Therefore, Rg3-MNs present broad prospects in the treatment of alopecia.

Evaluation of the relationship of digital phototrichogram findings of patients with diffuse hair loss with blood TSH, ferritin and vitamin B12 levels.

Telogen effluvium (TE) is a type of alopecia that is frequently seen in women. Among factors resulting in hair loss, many reasons such as endocrine diseases, nutrition disorders, stress, anemia, low ferritin levels, vitamin B12 deficiency, and thyroid diseases are found. A digital phototrichogram is one of the non-invasive methods of diagnosis in the evaluation of alopecia. In this study, it was aimed to compare biochemical parameters of female patients with diffuse hair loss with phototrichogram findings. 108 female patients with diffuse hair loss were included in the study. Patients were divided into two groups: acute and chronic TE, and a hair pull test was applied. Total blood count, blood biochemistry, iron, iron binding capacity, ferritin, thyroid stimulating hormone (TSH), sT3, sT4, folic acid, and vitamin B12 levels were examined. The telogen/anagen ratios and hair densities of patients were determined with a phototrichogram. The serum biochemical parameters (aspartate aminotransferase, alanine aminotransferase, urea, creatinine), TSH, sT3, sT4, and folic acid levels of patients were within normal limits. Telogen ratio, anagen ratio, hair density, number of shed hairs, family history, blood ferritin, TSH, and vitamin B12 levels were found to be similar between groups having acute and chronic TE. In our study, while mean anagen and telogen ratios with trichoscan were similar to literature data, no statistically significant correlation was determined between patients' ages and examined trichoscan findings (p>0.05). The hair pull test positivity of patients with chronic TE was higher compared to patients with acute TE (p<0.05). In patients with positive hair pull tests, the telogen ratio and hair density were found to be higher. In the group with <40 ng/mL ferritin level, the mean telogen ratio was detected to be significantly higher than the mean anagen ratio (p<0.05). No significant correlation was determined between vitamin B12 and TSH levels in patients and phototrichogram findings (p>0.05). The findings of this study showed that ferritin has an important role in diffuse hair loss, and the phototrichogram method is an auxiliary method for the physician in the diagnosis of TE.

Culprits of Medication-Induced Telogen Effluvium, Part 2.

Telogen effluvium (TE) is a common mechanism underlying medication-related alopecia. The inciting cause of TE may be difficult to identify due to delays in clinically apparent hair loss. Because medication-induced TE is a nonscarring alopecia that typically is reversible, appropriate management requires identification of the underlying trigger and cessation of potential culprit medications. In part 2 of this 2-part series on medication-induced TE, we focus on anticoagulant and antihypertensive medications.

Status of research on the development and regeneration of hair follicles.

Hair loss, or alopecia, is a prevalent condition in modern society that imposes substantial mental and psychological burden on individuals. The types of hair loss, include androgenetic alopecia, alopecia areata, and telogen effluvium; of them, androgenetic alopecia is the most common condition. Traditional treatment modalities mainly involve medical options, such as minoxidil, finasteride and surgical interventions, such as hair transplantation. However, these treatments still have many limitations. Therefore, exploring the pathogenesis of hair loss, specifically focusing on the development and regeneration of hair follicles (HFs), and developing new strategies for promoting hair regrowth are essential. Some emerging therapies for hair loss have gained prominence; these therapies include low-level laser therapy, micro needling, fractional radio frequency, platelet-rich plasma, and stem cell therapy. The aforementioned therapeutic strategies appear promising for hair loss management. In this review, we investigated the mechanisms underlying HF development and regeneration. For this, we studied the structure, development, cycle, and cellular function of HFs. In addition, we analyzed the symptoms, types, and causes of hair loss as well as its current conventional treatments. Our study provides an overview of the most effective regenerative medicine-based therapies for hair loss.

ALX4-related frontonasal dysplasia sequence presenting with alopecia in a 12 year old girl

Children with alopecia are frequently encountered in paediatric dermatological practice. Common causes include alopecia areata, and telogen effluvium. Herein we report a case of alopecia in a 12 year old girl as a part of ALX4-related frontonasal dysplasia (FND) sequence for its rarity.

Screening and Risk Factors for Alopecia

Alopecia, characterized by the loss of hair in various patterns and extents, presents a diverse spectrum of conditions with distinct etiologies and therapeutic considerations. This comprehensive review explores the common types of alopecia encountered in primary care, including telogen effluvium, male-and female-pattern hair loss, alopecia areata, traction alopecia, and tinea capitis. Diagnostic approaches encompass careful history-taking, physical examination, and, when needed, advanced techniques like dermatoscopy. Treatment strategies vary based on the type of alopecia, ranging from topical applications to systemic therapies. Understanding risk factors such as age, genetics, ethnicity, and medication associations is pivotal for tailored interventions. The prevention of specific types of alopecia involves targeted measures, such as wearing cooling caps during chemotherapy to minimize hair loss. By considering these factors, individuals and healthcare providers can collaboratively navigate alopecia, optimizing patient outcomes and quality of life

Characteristics of hair loss in COVID-19 patients in Thailand.

There is still a scarcity of data on hair loss caused by coronavirus disease 2019 (COVID-19) infection. This study aims to determine the characteristics of hair loss in Thai individuals after COVID-19 infection and to identify associated factors. From March to June 2022, a retrospective review of medical records and telephone interviews was conducted to determine the details of hair loss, the severity of infection, and the associated treatments of patients with an abrupt onset of hair loss after the diagnosis of COVID-19 infection at Siriraj Hospital in Bangkok, Thailand. This study included 43 patients who experienced hair loss within 4 months after COVID-19 infection. The mean age was 46.5 ± 14.5 years, predominantly women. Most had mild COVID-19 symptoms (59.3%), and 59.1% experienced weight loss, with a mean weight loss of 4.3 ± 2.0 kg per month. Preexisting hair loss was reported in 31.0% of participants, with approximately 3-quarters diagnosed with androgenetic alopecia. The median onset of hair loss after COVID-19 infection was 30 days (interquartile range 30-60). Telogen effluvium was the most common acute hair loss diagnosis, and topical minoxidil was the predominant treatment (95.3%). Female gender was correlated with a more severe shedding scale (adjusted odd ratio 24.76, 95% CI 1.67-168.86). Patients with a history of androgenetic alopecia tended to have a lower hair shedding scale (adjusted odd ratio 0.03, 95% CI 0.01-0.38). This study reviewed the characteristics of hair loss after COVID-19 infection during Omicron outbreaks in Thailand. The COVID-19-associated telogen effluvium, which is the primary cause in our patients, manifested with earlier onset at approximately 30 days.

COVID-19-induced hair shedding and related risk factors: A Saudi perspective.

Many cases of telogen effluvium (TE), acute hair shedding, following coronavirus disease 2019 (COVID-19) were reported during the pandemic. We conducted a cross-sectional study to assess the relationship between COVID-19 and TE in Saudi Arabia. Self-administered online questionnaires were distributed online between March and September 2022 in Saudi Arabia. A multivariate logistic regression model was used to determine risk factors associated with TE post-COVID-19 (significance at P < 0.05). Of the 703 responders, 392 were included in the study. 59.70% (n = 234) recognized hair shedding during or after COVID-19. The time taken to realize hair shedding (3 or 6 months) and the duration varied (3, 6, >6 months). The risk factors significantly related to TE post-COVID-19 were: female sex (P < 0.001, odds ratio [OR] = 2.98), COVID-19 antiviral treatment (P = 0.032, OR = 3.02), and TE history (P = 0.001, OR = 3.78). Healthcare providers and physicians should be aware of the relationship between TE and COVID-19, to easily recognize, treat, and improve their patients' outcomes).

Serum 25 hydroxyvitamin D in non-scarring alopecia: A systematic review and meta-analysis.

Non-scarring alopecia mainly includes androgenetic alopecia (AGA), female pattern hair loss (FPHL), alopecia areata (AA), telogen effluvium (TE), anagen effluvium (AE) and so on. Many studies had investigated the serum 25-hydroxyvitamin D level and vitamin D deficiency of patients with these diseases, but opinions varied, and no conclusion was reached. Relevant articles were retrieved through PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI) and other databases. Serum 25-hydroxyvitamin D [25(OH) D] levels and vitamin D deficiency were used as our primary outcome. The odds ratio (OR) and the standardized mean difference (SMD) with 95% confidence interval were both examined for vitamin D deficiency and levels. Our meta-analysis had included a total of 3374 non-scarring alopecia patients and 7296 healthy controls from 23 studies through the inclusion criteria and exclusion criteria. We found non-scarring alopecia had decreased serum 25(OH)D level (WMD -7.29; 95% CI -9.21, -5.38) and increased vitamin D deficiency incidence (OR 3.11 95% CI 2.29, 4.22), compared with healthy controls. This meta-analysis chose to conduct random-effect model and subgroup analysis, because of the high heterogeneity (serum 25(OH)D level: I2 = 95%, vitamin D deficiency: I2 = 0%). Patients with non-scarring alopecia (including AA, FPHL, AGA and TE) have insufficient serum level of 25(OH)D and increased incidence of vitamin D deficiency. Vitamin D supplementation and monitoring for vitamin D deficiency may be helpful in treating non-scarring alopecia.

Minoxidil oral en alopecias no androgénicas

For several years minoxidil has been used in medicine and trichology. Its mechanism of action remains unclear, it prolongs anagen, modulates angiogenesis and increases hair shaft thickness. New research suggests an antiandrogenic and immunomodulatory role. Low-dose oral minoxidil has proven to be an alternative for alopecia. The optimal dose for this purpose has not been established, it is probably different for children, women and men. Androgenic alopecia has been the most widely studied condition, there are other pathologies such as telogen effluvium, traction alopecia, alopecia areata, chemotherapy-induced alopecia, loose anagen hair syndrome, monilethrix, and scarring alopecia (fibrosing frontal alopecia and lichen planus pilaris). This literature review aims to expose the mechanism of action, pharmacokinetics, safety and efficacy of oral minoxidil in different types of non-androgenic alopecia.

Telogen effluvium: a 360 degree review.

Telogen effluvium (TE) is one of the most common presentations of diffuse non-cicatricial alopecia and is generally self-limited. Multiple causes are associated with TE onset and its maintenance, with stress being felt the most common factor. The multifactorial etiologies involved in TE makes it a complex disorder to diagnose and treat often placing this entity into a "waste basket" diagnosis. By critically assessing the available scientific literature we aimed to review the multifaceted aspects of TE. Our objectives were to review the pathogenesis with the role of stress (including Coronavirus 19-associated TE), as well as to describe the main clinical findings, its differential diagnosis and the current knowledge on TE treatments along with the future treatment's insights.

Efficacy of Adipocyte-Derived Stem Cells-Conditioned Media in Telogen Effluvium.

To assess the effectiveness of adipocyte-derived mesenchymal stem cells-conditioned media (ADSC-CM) formulation in telogen effluvium patients. A retrospective cohort study was conducted at a dermatology clinic in Jeddah, Saudi Arabia. The study included 50 consecutive patients aged 20-70 years, who were diagnosed with telogen effluvium. All patients received five monthly sessions of the same commercial ADSC-CM formulation, using a standardized application protocol. Pre- and post-intervention changes in trichometry parameters were analyzed. There was a significant increase in mean hair density (up to 29.01 hair/cm2; effect size 0.7-1.0), cumulative hair thickness (up to 2.67 units; effect size 0.7-1.4), and the number of follicular hair units (up to 19.96%; effect size 1.0-1.3) in all scalp regions (p < 0.001), associated with a decrease in mean trichometry-derived Sinclair scale by 0.8-1.3 (p < 0.001). Positive outcomes were observed in 70%-92% of the patients depending on the parameter and scalp region. There was no impact of the patient's age on ADSC-CM efficacy. ADSC-CM was successfully applied as a new treatment option for patients with telogen effluvium. These findings provide another therapeutic and research area for dermatologists to optimize the management of telogen effluvium and reduce its impact on patients.

Astragalus membranaceus and Cinnamomum cassia Stimulate the Hair Follicle Differentiation-Related Growth Factor by the Wnt/β-Catenin Signaling Pathway.

Astragalus membranaceus and Cinnamomum cassia are used as spices and flavorful ingredients, or medicinal herbs with pharmacological effects. In this study, the hair-growth-promoting effects of the YH complex, a newly developed formula consisting of membranaceus and C. cassia, are investigated with the prediction of its molecular mechanism. The target gene of the YH complex was about 74.8% overlapped with the gene set of 'Hair growth' on the GO Biological Process database. The oral administration of the YH complex promoted hair regrowth and increased hair-shaft thickness in depilated hair loss mice. In addition, the anagen/telogen hair follicle ratio was significantly increased by the YH complex. The growth factors affecting the growth of hair follicles were dose-dependently increased by treatment with the YH complex. The Wnt/β-catenin signaling pathway expressions in skin tissues were apparently increased by the administration of the YH complex. In conclusion, the YH complex consisting of A. membranaceus and C. cassia induced hair follicle differentiation and preserved the growing-anagen phase by increasing growth factors and the Wnt/β-catenin signaling pathway, leading to the restoration of hair loss. The YH complex can be a remedy for hair loss diseases, such as alopecia areata, androgenetic alopecia, telogen effluvium, and chemotherapy-induced alopecia.

A Review of Hair Anatomy and Animal Models for Alopecia

Hair is part of the integumentary system and it sits in the hair follicle, which extends into the skin. Hair serves several functions, including protecting the skin and regulating body temperature. Understanding the hair growth cycle is crucial as it is a complex process that involves four distinct phases: Anagen, Catagen, Telogen, and Exogen. These phases are regulated by various factors, such as hormones and genetics. An imbalance in the hair growth cycle can lead to hair loss or Alopecia, Various etiological factors cause hair loss; these include genetic factors, hormonal imbalances, medication, poor diet intake, smoking and environmental factors. In general, alopecia classified into Alopecia areata, Androgenic alopecia, Alopecia universalis, Involutional alopecia, Telogen effluvium, Trichotillomania, and Scarring alopecia. Several animal models have been utilized to study the pathophysiology of Alopecia. These models include mice, and rats similar to human hair and physiology used to study the pathway of Alopecia. Based on the type of Alopecia, animal models differ as androgenic Alopecia occurs due to testosterone sensitivity or due to the Dihydrotestosterone (DHT) hormone, chemotherapy-induced alopecia and alopecia areata by using transgenic animals and C3H/HeJ mice models. The present review provides insight into the anatomy and physiology of the hair and utilizes animal models which can aid in developing new treatment approaches for Alopecia.

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.