Telogen effluvium in daily practice: Patient characteristics, laboratory parameters, and treatment modalities of 3028 patients with telogen effluvium

Abstract

Background Telogen effluvium (TE) is a common form of non‐scarring alopecia, characterized by excessive shedding of telogen club hairs. Objectives The aim of the present study was to investigate patient characteristics, laboratory parameters, and treatment strategies in TE. Methods Electronic records of 3028 patients were retrospectively analyzed. Demographic and clinical data, as well as serum parameters screening for iron, vitamin B12, vitamin D, folate and zinc deficiencies, thyroid function, and ANA titers, were evaluated. Results In the study group, the most frequently performed test type was serum ferritin level (82.3%), followed by complete blood count (81%), both of which revealed that 6.2% of the patients had iron deficiency anemia. 4.6% of the patients had thyroid dysfunction. In screened patients, vitamin and mineral deficiencies were as follows: vitamin D (72.2%), vitamin B12 (30.7%), folate (4.4%), and zinc (2.1%). Women were more likely to be prescribed vitamin D replacement therapy. Iron replacement was the most frequently ordered treatment, comprising 37.5% of total prescriptions. Conclusion To the best of our knowledge, this is the most comprehensive retrospective study having the largest number of patients with TE. Our results will not only help to augment knowledge about TE, but also provide a diagnostic algorithm for the laboratory and clinical workup of patients with TE.

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“…An additional survey on TE and treatment using search string 3 identified 11 papers (Table 1 ). 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 Currently, no established treatments or guidelines on TE treatment are available. 23 Various studies on treatment have been conducted.…”

“… 23 Various studies on treatment have been conducted. 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 The most common treatment was oral minoxidil (Table 3 ). 28 , 29 , 30 Literature reviews of 17 studies with 634 patients receiving oral minoxidil as the primary treatment for hair loss indicated that oral minoxidil was an effective and well‐tolerated primary medication to treat not only AGA but also other types of alopecia, including TE and AA with only minor adverse events.…”

“…Besides minoxidil, promise of various therapeutic approaches, including biotin 31 or iron 32 supplementation, growth factors vacuolated through iontophoresis, 33 antioxidant and anti‐inflammatory shampoo and lotion, 34 vitamin D 3 intake, 35 microneedles, 36 sandalwood, 37 and photobiostimulation combined with microinjection, 38 have been explored to treat TE. Other remedies, which was not retrieved by search string 3, including an oral formulation containing l‐cystine, thiamin, calcium d‐pantothenate, medicinal yeast, keratin and p‐aminobenzoic acid, may also be beneficial to improve TE; 43 however, current evidence levels are relatively low and high‐quality, specific, prospectively designed, randomized controlled trials are essential to establish their efficacy.…”

“… 28–38 Currently, no established treatments or guidelines on TE treatment are available 23 . Various studies on treatment have been conducted 28–38 . The most common treatment was oral minoxidil (Table 3).…”

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“…This should prompt a physician to do a more extensive laboratory work at an earlier time rather than waiting to see if the patient experiences severe symptoms. There is also evidence that other laboratory abnormalities can cause telogen effluvium, such as vitamin D deficiency and vitamin B12 deficiency 9–11 . Vitamin D has been found to be an important regulator of keratinocyte differentiation and proliferation, which are both essential processes to maintaining healthy hair growth 10 .…”