A 23-year-old woman comes to the office due to hair loss. Two weeks ago, she suddenly developed loss of large numbers of hair fibers when washing or brushing her hair. The patient has had 2 pregnancies; the first led to a spontaneous abortion at 13 weeks, and the second led to a normal term vaginal delivery 4 months ago. She subsequently experienced severe postpartum unipolar major depression requiring psychiatric hospitalization. Current medications include fluoxetine and olanzapine. The patient is not breastfeeding. She does not use tobacco, alcohol, or illicit drugs. Vital signs are normal. Examination shows diffuse hair loss with no erythema or scaling in the scalp. When tracts of hair are pulled firmly, 20% of fibers are pulled out. Which of the following is the most likely diagnosis for this patient's hair loss?

Question

A 23-year-old woman comes to the office due to hair loss.  Two weeks ago, she suddenly developed loss of large numbers of hair fibers when washing or brushing her hair.  The patient has had 2 pregnancies; the first led to a spontaneous abortion at 13 weeks, and the second led to a normal term vaginal delivery 4 months ago.  She subsequently experienced severe postpartum unipolar major depression requiring psychiatric hospitalization.  Current medications include fluoxetine and olanzapine.  The patient is not breastfeeding.  She does not use tobacco, alcohol, or illicit drugs.  Vital signs are normal.  Examination shows diffuse hair loss with no erythema or scaling in the scalp.  When tracts of hair are pulled firmly, >20% of fibers are pulled out.  Which of the following is the most likely diagnosis for this patient's hair loss?

Quizplus · Accepted Answer

Explanation: 11ec25c8_d379_e241_bc81_173d2a9eb37a_MD0003_00 This patient has acute, diffuse, noninflammatory hair loss consistent with telogen effluvium (TE), one of the most common causes of hair loss in adults. Hair follicles pass through 3 phases: Growth phase (anagen; 90% of follicles) Transformative phase (catagen; <1%) Rest/shedding phase (telogen; 10%). In TE, follicles undergo a widespread shift into the rest/shedding phase, with cessation of growth and subsequent shedding. It is often triggered by a stressful event, such as weight loss, pregnancy, major illness or surgery, or psychiatric trauma. Patients with TE have widespread thinning of hair but the scalp and hair shafts appear normal. In the hair pull test, small tracts of hair (50-60 fibers) are pulled firmly; extraction of >10%-15% of fibers is abnormal and suggests TE. It is a self-limited disorder but may take up to a year to resolve completely. (Choice A) Alopecia areata is an autoimmune disorder characterized by circumscribed patches of hair loss. Hair shafts show narrowing close to the surface and may be broken off. (Choice B) Androgenetic alopecia causes uneven hair loss in a characteristic pattern. Men have thinning at the frontotemporal hairline and vertex; women predominantly have thinning at the vertex and sides with preservation of the hairline. (Choice C) Seborrheic dermatitis causes erythema and scaling at the ears, eyebrows, nasolabial folds, and scalp. (Choice E) Tinea capitis is a superficial dermatophyte infection characterized by pruritic, scaly, erythematous patches with hair loss. Proximal hair shafts may be visualized as small dots in the area of hair loss. (Choice F) Trichorrhexis nodosa is characterized by fragility of hair with breaking of strands. It can be congenital or acquired (eg, excessive heat, hair dyes, salt water). Close inspection shows fractured strands with splitting of fibers. (Choice G) Trichotillomania is a behavioral disorder characterized by compulsive pulling of hair. It presents with irregular patches of hair loss and broken fibers, and typically affects the front and sides of the scalp, eyebrows, and eyelashes. Educational objective: Telogen effluvium causes acute, diffuse, noninflammatory hair loss. It is often triggered by a stressful event, such as weight loss, pregnancy, major illness or surgery, or psychiatric trauma. Patients have widespread thinning of hair but the scalp and hair shafts appear normal. It is a self-limited disorder but may take up to a year to resolve completely. References: Hair loss: common causes and treatment. (http://www.ncbi.nlm.nih.gov/pubmed/28925637)

A 23-Year-Old Woman Comes to the Office Due to Hair