Quantitating Hair Loss in Women: A Critical Approach

Guarrera, Marcella; Semino, M.T.; Rebora, Alfredo

doi:10.1159/000246049

Cited by 48 publications

(29 citation statements)

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“…Pruritus was not considered, and specific dermatologic diseases of the scalp were excluded. Hair loss was quantified by a hair pull, daily count and wash test, and telogen percentage was obtained by a hair pluck (trichogram), as previously described [10]. The scalp surface was examined by dermatoscopy (×10 Heine optics).…”

Section: Methodsmentioning

confidence: 99%

Hair Pain (Trichodynia): Frequency and Relationship to Hair Loss and Patient Gender

Willimann

Trüeb²

2002

Dermatology

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Background: Patients complaining of hair loss frequently claim that their hair has become painful. Objective and Methods: The aim of the study was to evaluate the frequency of this phenomenon and its relationship to hair loss. Patients seeking advice for hair loss either spontaneously reported or were questioned about painful sensations of the scalp. Hair loss activity was quantified by a hair pull, daily count and wash test. Telogen percentage was obtained by a hair pluck. The scalp surface was examined by dermatoscopy. Results: Of 403 examined patients, 20% of women and 9% of men reported hair pain, irrespective of the cause and activity of hair loss. A minority presented scalp telangiectasia. This strongly correlated with hair pain. Conclusions: Hair pain (trichodynia) affects a significant proportion of patients complaining of hair loss and may increase the anxiety. The symptom neither allows discrimination of the cause nor correlates with the activity of hair loss. A higher prevalence of female patients might be connected to gender-related differences in pain perception in relation to anxiety. The role of vasoactive neuropeptides in the interaction between the central nervous system and skin reactivity is discussed. In the absence of any correlation with quantitative parameters of hair loss or specific morphologic changes of the scalp, management remains empiric and tailored to the individual.

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Section: Methodsmentioning

confidence: 99%

Hair Pain (Trichodynia): Frequency and Relationship to Hair Loss and Patient Gender

Willimann

Trüeb²

2002

Dermatology

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“…Lithium [55] HPV vaccine [56] Pramipexole (dopamine agonist used in Parkinson's disease) [57] Lamotrigine [58] Magnesium valproate, [58] Dietary inadequacy [59] Anorexia nervosa [21] Vigorous weight reduction [25,60] TG: Telogen gravidarum, TE: Telogen effl uvium, AGA: Androgenetic alopecia, HPV: Human papilloma virus [4] Hospitalization Hemorrhage [23] Bereavement, emotional stress [24] Changes in medication Crash-diets [25] Postpartum (TG) [10] Heavy metals: Arsenic, [26] thallium, [27] and selenium [28] Actinic effl uvium: Sunlight and UV light induced [29,30] Seasonal variation (July to October) [31] Contd... [61] A vigorous shampooing at baseline; No shampooing on day 2-4; Comb hair only once a day; Collect all the hair lost for 3 days and count Normal average daily loss: 40-180 hair/d [61] Mean hair loss from healthy scalp: 28-35/d [62] Mean hair loss in women complaining of hair loss (with normally dense hair): <50/day [63] The magic number of 100, so often referred to in textbooks and found in the lay press, should be seriously revisited [61] Fewer than 50 hairs can be signifi cantly abnormal in a patient having lost 50% of his hair [61] Hair pull test [64][65][66] No shampooing for 24 hours; Grasp about 60 hairs between the thumb and fi ngers; Pull gently but fi rmly from root to tip; Repeat in all four quadrants of the scalp and bitemporal areas Negative test: Less than 10% hairs obtained, indicates normal shedding, Positive test: More than 10% hair pulled out; indicates a process of active hair shedding [64] Interpretation: Positive in both TE and diffuse alopecia areata (AA); however, in AA exclamation point hairs will be seen Advantages:…”

Section: Advanced Malignancymentioning

confidence: 99%

Telogen effluvium

Grover¹,

Khurana²

2013

Indian J Dermatol Venereol Leprol

101

107

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Telogen effluvium (TE) is one of the most common causes of diffuse nonscarring hair loss. In its acute form, it generates a lot of anxiety in the patient, which can be significantly allayed with a confident diagnosis. In its more chronic form, however, the hair loss may go unnoticed for long periods of time. Here in, the dermatologist's role in differentiating it from the more common patterned hair loss is significant. Differentiating TE from other causes of diffuse nonscarring hair loss can indeed be a daunting task and TE is often used as a waste basket diagnosis. 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. This review aims at summarizing our current level of knowledge with respect to this very common cause of hair loss. An attempt is made to help the readers reliably differentiate TE from other causes of diffuse nonscarring hair loss. The possible causative factors, pathogenetic mechanisms, clinical presentation, and possible treatment options are discussed.

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“…It is based on a gentle pulling of hairs collecting those about to reach teloptosis [86,90]. It seems to be useful in acute and severe conditions, but it is less sensitive in slowly evolving conditions.…”

Section: Hair Pull Testmentioning

confidence: 99%

EEMCO Guidance for the Assessment of Hair Shedding and Alopecia

Pierard

Piérard-Franchimont

Marks

et al. 2004

Skin Pharmacol Physiol

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Knowledge of the hair follicle anatomy and the dynamics of hair cycling is substantial. Recognizing the anagen, catagen and telogen phases as well as teloptosis and the hair eclipse phenomenon clearly characterizes the typical hair chronobiology. Physiological modulators include hormones, neuromediators, miscellaneous biomolecules, seasons, micro-inflammation and ageing. For individuals who present with the complaint of increased hair shedding or alopecia, a host of evaluation techniques are available in addition to history, physical examination and laboratory assessment. Various clinical hair techniques can help in assessing the efficacy of drugs and cosmetics on hair growth. The methods are quite similar to those used to establish a definite diagnosis in dermatological practice. Great strides have been made during the recent decades in the methodology of hair growth trials in dermatology and cosmetology. Clinical evaluations benefit from a few additional specific techniques that enhance the perception of hair (re-) growth, shedding and alopecia. These assessments include the determination of hair patterning and density that may be helped by the ‘black-and-white felt’ examination. Daily hair counts, the ‘hair pull test’ and the ‘hair feathering test’ are also available. Instrumental methods provide reliable quantitative information that is useful if there are adequate controls. Some photographic methods, the trichogram, hair weighing and variants of the hair growth window technique including the phototrichogram, videotrichogram and tractio-phototrichogram provide insight into the complexities of hair cycling and shedding. Skin biopsy is indicated for diagnostic purposes, especially when the hair loss is accompanied by scarring.

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Quantitating Hair Loss in Women: A Critical Approach

Cited by 48 publications

References 0 publications

Hair Pain (Trichodynia): Frequency and Relationship to Hair Loss and Patient Gender

Hair Pain (Trichodynia): Frequency and Relationship to Hair Loss and Patient Gender

Telogen effluvium

EEMCO Guidance for the Assessment of Hair Shedding and Alopecia

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