Diffuse alopecia in females: An update.
Corresponding Author(s) : Dr. Usha Kataria
ushachillar@gmail.com
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 3 No. 1 (2015): 2015 Volume 3- Issue -1
Abstract
Scalp hairs complete the body self-image and patients with diffuse alopecia suffer from overt disfiguration, leading to psycho-social embarrassment and significant lack of self esteem. Diffuse alopecia is a non-scarring type of alopecia. Telogen effluvium is the most common cause of diffuse alopecia in females. Abrupt, rapid, generalized shedding of club hairs, 2-3 months after a triggering event like parturition, high fever, major surgery etc. indicates telogen effluvium, while gradual diffuse hair loss with thinning or widening of central parting line indicates female pattern hair loss, another common cause of diffuse alopecia. Excessive alarming diffuse hair loss, from a normal looking ahead without an obvious cause,is the hallmark of chronic telogen effluvium, which is a distinct entity different from telogen effluvium and female pattern hair loss. Hence an early diagnosis and an aggressive treatment in the case of active hair loss are crucial in the management of diffuse alopecia.
Keywords
Diffuse alopecia
females
non-scarring
pattern
Telogen Effluvium
1.
Dr. Usha Kataria. Diffuse alopecia in females: An update. Int. J. of Allied Med. Sci. and Clin. Res. [Internet]. 2020 Aug. 3 [cited 2025 Sep. 26];3(1):27-31. Available from: https://ijamscr.com/ijamscr/article/view/132
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References
-
[1] Jain VK, Kataria U, Dayal S. Study of diffuse alopecia in females. Indian J Dermatol venereol Leprol. 2000 Mar- April 66 (2)
[2] Vogt A, McElvee K, Blume- Peytavi U. Biology of hair follicle. In: Blume- Peytavi U, Tosti A, Whiting D, Trueb R, editors. Textbook on hair – From basic science of clinical application. Berlin Springer Verlag; 2008.p.1-22.
[3] Harrison S, Sinclair R. Telogen effluvium. Clin Exp Dermatol 2002; 27:389-5.
[4] Kligman AM. The human hair cycle. J Invest Dermatol 1959; 33:307- 16.
[5] Trueb RM. Diffuse hair loss. In: Blume – Peytavi U, Tosti A, Whiting DA, Trueb RM, editors. Hair Growth and Disorders. Berlin: Springer; 2008.p.259-72.
[6] Paus R, Oslan EA, Messenger AG. Hair Growth Disorders. In: Wolff K,Goldsmith LA, Katz SI Gilchrest BA, Zller As, Leffell DJ, editiors.Fitzpatrick’s Dermatology in General Medicine.7th ed., vol, 2. New York: McGraw – Hill; 2008.p. 753 -77.
[7] Sperling LC. Hair and systemic disease. Dermatol Clin 2001; 19:711-26.
[8] Sinclair R, Grossman KL, KvedarJC. Anagen hair loss, in Disorders of Hair Growth: Diagnosis and Treatment. In: Olsen EA, editor. McGraw-Hill: New York; 2002.p.275.
[9] Delmonte S, Semino MT, Parodi A, Rebora A.Normal anagen effluvium: A sign of pemphigus vulgaris. Br J Dermatol 2000; 142:1244-5.
[10] Quercetani R, Rebora AE, Fedi MC, Carelli G, Mei S, Chelli A, et al. Patients with profuse hair shedding may reveal anagen hair dystrophy :A diagnostic clue of alopecia areata incognita. J Eur Acad Dermatol Venereol 2011; 25:808-10.
[11] Bank WJ, Pleasure DE, Suzuki K,Nigro M,KatzThallium poisoning. Arch Neurol 1972; 26:456-64.
[12] Elhassani SB. The many faces of methyl mercury poisoning. J Toxicol Clin Toxicol 1982; 19:875-906.
[13] Vowels M, Chan LL,Giri N, Russell S,Lam-Po-Tang R. Factors affecting hair regrowth after bone marrow transplantation. Bone Marrow Transplant 1993; 12:347-50.
[14] Tosti A,Pazzaglia M.Drug reactions affecting hair: Diagnosis. Dermatol Clin 2007; 25:223-31.
[15] Trueb R. Chemotherapy – induced Hair Loss. Skin Therapy Lett 2010;15:5-7
[16] Sehgal VN, Kak R, Aggarwal A, Srivastava G, Rajput P.Male pattern androgenetic alopecia in an Indian context: A perspective study. J Eur Acad Dermatol Venereol 2007; 21:473-9.
[17] Girman CJ, Hartmaier S, Roberts J, Bergfeld W, Waldstreicher J. Patient –perceived importance of negative effects of androgenetic alopecia in women. J Womens Gend Based Med 1999; 8:1091-5.
[18] Norwood OT. Incidence of female androgenetic alopecia (female pattern alopecia). Dermatol Surg 2001; 27:53-4.
[19] Wang TL Zhou C, Shen YW,Wang XY, Ding XL, Tian S, et al. Prevalence of androgenetic alopecia in China: A community-based study in six cities. Br J Dermatol 2010; 162:843-7.
[20] Gan DC, Sinclair RD. Prevalence of male and female pattern hair loss in Maryborough. J Invest Dermatol Symp Proc 2005; 10:184-9.
[21] Paus R, Cotsarelis G. The biology of hair follicles. N Engl J Med 1999; 341:491-7.
[22] Pierard – Franchimont C, Pierard GE. Teloptosis, a turning point in hair shedding biorhythms. Dermatology 2001; 203:115-7.
[23] Ludwing E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Br J Dermatol 1977; 97:247-54.
[24] Camacho – Martinez FM. Hair loss in women. Semin Cutan Med Surg 2009; 28:19-32.
[25] Olsen EA. Female pattern hair loss. J Am Acad Dermatol 2001; 45:S70-80.
[26] Kligman AM. Pathologic dynamics of human hair loss. Telogen effluvium. Arch Dermatol 1961; 83:175-98.
[27] Gilmore S, Sinclair R. Chronic telogen effluvium is due to a reduction in the variance of anagen duration. Australas J Dermatol2010; 51:163-7.
[28] De Berker D. Clinical relevance of hair microscopy in alopecia. Clin Exp Dermatol 2002; 27:366-72.
[29] Headington JT Telogen effluvium. New concepts and review. Arch Dermatol 1993; 129:356-63.
[30] Dawber RPR, Simpson NB, Barth JH. Diffuse alopecia: Endocrine, metabolic and chemical influences on the follicular cycle. In: Dawer RP,editor. Diseases of the hair and scalp. Oxford: Blackwell Science; 1997.p.123-50.
[31] Hadshiew IM, Foitzik K, Arck PC, Paus R. Burden of hair loss. Stress and the underestimated psychosocial impact of telogen effluvium and androgeneticalopecia J Invest Dermatol 2004; 123:455-7.
[32] Goette DK, Odom RB. Alopecia in crash dieters. JAMA 1976; 235:2622-3.
[33] Trueb RM. Is androgenetic alopecia a photo aggravated dermatosis. Dermatology 2003; 207:343-8.
[34] Braida D, Dubief C, Lang G. Photo ageing of hair fiber and photo protection. Skin Pharmacol 1994; 7:73-7.
[35] Pierard –Franchimont C, Peerard GE. L’effluvium telogene actinique: Une facette de la chronobiologie humaine. Int J Cosmet Sci 1999; 21:15-21.
[36] Whiting DA, Chronic telogen effluvium: increased scalp hair shedding in middle aged women. J Am Acad Dermatol 1996; 35:899-906.
[37] Messanger AG, de Berker DA, Sinclair RD. Disorders of Hair. In: Burns T, Breathnach S, Cox N, Griffits C, editiors. Rooks textbook of Dermatology. 8th ed. UK: Blackwell Publishing Ltd; 2010.p.66.27-66.
[38] Sinclair R. Diffuse hair loss. Int J Dermatol 1999; 38 (suppl 1):8-18.
[39] Rushton DH, Ramsey ID, James KC, Norris MJ, Gilkes JJ. Biochemical and trichological characterization of diffuse alopecia in women. Br J Dermatol 1990; 123:187-97.
[40] Kaimal S, Thappa DM. Diet in dermatology: Revisited. Indian J Dermatol Venereol Leprol 2010; 76:103-15.
[41] Rushton DH. Nutritional factors and hair loss. Clin Exp Dermatol 2002; 27:396-404.
[42] Dawber RP,Connor BL. Pregnancy, hair loss, and the pill. Br Med J 1971; 4:234.
References
[1] Jain VK, Kataria U, Dayal S. Study of diffuse alopecia in females. Indian J Dermatol venereol Leprol. 2000 Mar- April 66 (2)
[2] Vogt A, McElvee K, Blume- Peytavi U. Biology of hair follicle. In: Blume- Peytavi U, Tosti A, Whiting D, Trueb R, editors. Textbook on hair – From basic science of clinical application. Berlin Springer Verlag; 2008.p.1-22.
[3] Harrison S, Sinclair R. Telogen effluvium. Clin Exp Dermatol 2002; 27:389-5.
[4] Kligman AM. The human hair cycle. J Invest Dermatol 1959; 33:307- 16.
[5] Trueb RM. Diffuse hair loss. In: Blume – Peytavi U, Tosti A, Whiting DA, Trueb RM, editors. Hair Growth and Disorders. Berlin: Springer; 2008.p.259-72.
[6] Paus R, Oslan EA, Messenger AG. Hair Growth Disorders. In: Wolff K,Goldsmith LA, Katz SI Gilchrest BA, Zller As, Leffell DJ, editiors.Fitzpatrick’s Dermatology in General Medicine.7th ed., vol, 2. New York: McGraw – Hill; 2008.p. 753 -77.
[7] Sperling LC. Hair and systemic disease. Dermatol Clin 2001; 19:711-26.
[8] Sinclair R, Grossman KL, KvedarJC. Anagen hair loss, in Disorders of Hair Growth: Diagnosis and Treatment. In: Olsen EA, editor. McGraw-Hill: New York; 2002.p.275.
[9] Delmonte S, Semino MT, Parodi A, Rebora A.Normal anagen effluvium: A sign of pemphigus vulgaris. Br J Dermatol 2000; 142:1244-5.
[10] Quercetani R, Rebora AE, Fedi MC, Carelli G, Mei S, Chelli A, et al. Patients with profuse hair shedding may reveal anagen hair dystrophy :A diagnostic clue of alopecia areata incognita. J Eur Acad Dermatol Venereol 2011; 25:808-10.
[11] Bank WJ, Pleasure DE, Suzuki K,Nigro M,KatzThallium poisoning. Arch Neurol 1972; 26:456-64.
[12] Elhassani SB. The many faces of methyl mercury poisoning. J Toxicol Clin Toxicol 1982; 19:875-906.
[13] Vowels M, Chan LL,Giri N, Russell S,Lam-Po-Tang R. Factors affecting hair regrowth after bone marrow transplantation. Bone Marrow Transplant 1993; 12:347-50.
[14] Tosti A,Pazzaglia M.Drug reactions affecting hair: Diagnosis. Dermatol Clin 2007; 25:223-31.
[15] Trueb R. Chemotherapy – induced Hair Loss. Skin Therapy Lett 2010;15:5-7
[16] Sehgal VN, Kak R, Aggarwal A, Srivastava G, Rajput P.Male pattern androgenetic alopecia in an Indian context: A perspective study. J Eur Acad Dermatol Venereol 2007; 21:473-9.
[17] Girman CJ, Hartmaier S, Roberts J, Bergfeld W, Waldstreicher J. Patient –perceived importance of negative effects of androgenetic alopecia in women. J Womens Gend Based Med 1999; 8:1091-5.
[18] Norwood OT. Incidence of female androgenetic alopecia (female pattern alopecia). Dermatol Surg 2001; 27:53-4.
[19] Wang TL Zhou C, Shen YW,Wang XY, Ding XL, Tian S, et al. Prevalence of androgenetic alopecia in China: A community-based study in six cities. Br J Dermatol 2010; 162:843-7.
[20] Gan DC, Sinclair RD. Prevalence of male and female pattern hair loss in Maryborough. J Invest Dermatol Symp Proc 2005; 10:184-9.
[21] Paus R, Cotsarelis G. The biology of hair follicles. N Engl J Med 1999; 341:491-7.
[22] Pierard – Franchimont C, Pierard GE. Teloptosis, a turning point in hair shedding biorhythms. Dermatology 2001; 203:115-7.
[23] Ludwing E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Br J Dermatol 1977; 97:247-54.
[24] Camacho – Martinez FM. Hair loss in women. Semin Cutan Med Surg 2009; 28:19-32.
[25] Olsen EA. Female pattern hair loss. J Am Acad Dermatol 2001; 45:S70-80.
[26] Kligman AM. Pathologic dynamics of human hair loss. Telogen effluvium. Arch Dermatol 1961; 83:175-98.
[27] Gilmore S, Sinclair R. Chronic telogen effluvium is due to a reduction in the variance of anagen duration. Australas J Dermatol2010; 51:163-7.
[28] De Berker D. Clinical relevance of hair microscopy in alopecia. Clin Exp Dermatol 2002; 27:366-72.
[29] Headington JT Telogen effluvium. New concepts and review. Arch Dermatol 1993; 129:356-63.
[30] Dawber RPR, Simpson NB, Barth JH. Diffuse alopecia: Endocrine, metabolic and chemical influences on the follicular cycle. In: Dawer RP,editor. Diseases of the hair and scalp. Oxford: Blackwell Science; 1997.p.123-50.
[31] Hadshiew IM, Foitzik K, Arck PC, Paus R. Burden of hair loss. Stress and the underestimated psychosocial impact of telogen effluvium and androgeneticalopecia J Invest Dermatol 2004; 123:455-7.
[32] Goette DK, Odom RB. Alopecia in crash dieters. JAMA 1976; 235:2622-3.
[33] Trueb RM. Is androgenetic alopecia a photo aggravated dermatosis. Dermatology 2003; 207:343-8.
[34] Braida D, Dubief C, Lang G. Photo ageing of hair fiber and photo protection. Skin Pharmacol 1994; 7:73-7.
[35] Pierard –Franchimont C, Peerard GE. L’effluvium telogene actinique: Une facette de la chronobiologie humaine. Int J Cosmet Sci 1999; 21:15-21.
[36] Whiting DA, Chronic telogen effluvium: increased scalp hair shedding in middle aged women. J Am Acad Dermatol 1996; 35:899-906.
[37] Messanger AG, de Berker DA, Sinclair RD. Disorders of Hair. In: Burns T, Breathnach S, Cox N, Griffits C, editiors. Rooks textbook of Dermatology. 8th ed. UK: Blackwell Publishing Ltd; 2010.p.66.27-66.
[38] Sinclair R. Diffuse hair loss. Int J Dermatol 1999; 38 (suppl 1):8-18.
[39] Rushton DH, Ramsey ID, James KC, Norris MJ, Gilkes JJ. Biochemical and trichological characterization of diffuse alopecia in women. Br J Dermatol 1990; 123:187-97.
[40] Kaimal S, Thappa DM. Diet in dermatology: Revisited. Indian J Dermatol Venereol Leprol 2010; 76:103-15.
[41] Rushton DH. Nutritional factors and hair loss. Clin Exp Dermatol 2002; 27:396-404.
[42] Dawber RP,Connor BL. Pregnancy, hair loss, and the pill. Br Med J 1971; 4:234.
[2] Vogt A, McElvee K, Blume- Peytavi U. Biology of hair follicle. In: Blume- Peytavi U, Tosti A, Whiting D, Trueb R, editors. Textbook on hair – From basic science of clinical application. Berlin Springer Verlag; 2008.p.1-22.
[3] Harrison S, Sinclair R. Telogen effluvium. Clin Exp Dermatol 2002; 27:389-5.
[4] Kligman AM. The human hair cycle. J Invest Dermatol 1959; 33:307- 16.
[5] Trueb RM. Diffuse hair loss. In: Blume – Peytavi U, Tosti A, Whiting DA, Trueb RM, editors. Hair Growth and Disorders. Berlin: Springer; 2008.p.259-72.
[6] Paus R, Oslan EA, Messenger AG. Hair Growth Disorders. In: Wolff K,Goldsmith LA, Katz SI Gilchrest BA, Zller As, Leffell DJ, editiors.Fitzpatrick’s Dermatology in General Medicine.7th ed., vol, 2. New York: McGraw – Hill; 2008.p. 753 -77.
[7] Sperling LC. Hair and systemic disease. Dermatol Clin 2001; 19:711-26.
[8] Sinclair R, Grossman KL, KvedarJC. Anagen hair loss, in Disorders of Hair Growth: Diagnosis and Treatment. In: Olsen EA, editor. McGraw-Hill: New York; 2002.p.275.
[9] Delmonte S, Semino MT, Parodi A, Rebora A.Normal anagen effluvium: A sign of pemphigus vulgaris. Br J Dermatol 2000; 142:1244-5.
[10] Quercetani R, Rebora AE, Fedi MC, Carelli G, Mei S, Chelli A, et al. Patients with profuse hair shedding may reveal anagen hair dystrophy :A diagnostic clue of alopecia areata incognita. J Eur Acad Dermatol Venereol 2011; 25:808-10.
[11] Bank WJ, Pleasure DE, Suzuki K,Nigro M,KatzThallium poisoning. Arch Neurol 1972; 26:456-64.
[12] Elhassani SB. The many faces of methyl mercury poisoning. J Toxicol Clin Toxicol 1982; 19:875-906.
[13] Vowels M, Chan LL,Giri N, Russell S,Lam-Po-Tang R. Factors affecting hair regrowth after bone marrow transplantation. Bone Marrow Transplant 1993; 12:347-50.
[14] Tosti A,Pazzaglia M.Drug reactions affecting hair: Diagnosis. Dermatol Clin 2007; 25:223-31.
[15] Trueb R. Chemotherapy – induced Hair Loss. Skin Therapy Lett 2010;15:5-7
[16] Sehgal VN, Kak R, Aggarwal A, Srivastava G, Rajput P.Male pattern androgenetic alopecia in an Indian context: A perspective study. J Eur Acad Dermatol Venereol 2007; 21:473-9.
[17] Girman CJ, Hartmaier S, Roberts J, Bergfeld W, Waldstreicher J. Patient –perceived importance of negative effects of androgenetic alopecia in women. J Womens Gend Based Med 1999; 8:1091-5.
[18] Norwood OT. Incidence of female androgenetic alopecia (female pattern alopecia). Dermatol Surg 2001; 27:53-4.
[19] Wang TL Zhou C, Shen YW,Wang XY, Ding XL, Tian S, et al. Prevalence of androgenetic alopecia in China: A community-based study in six cities. Br J Dermatol 2010; 162:843-7.
[20] Gan DC, Sinclair RD. Prevalence of male and female pattern hair loss in Maryborough. J Invest Dermatol Symp Proc 2005; 10:184-9.
[21] Paus R, Cotsarelis G. The biology of hair follicles. N Engl J Med 1999; 341:491-7.
[22] Pierard – Franchimont C, Pierard GE. Teloptosis, a turning point in hair shedding biorhythms. Dermatology 2001; 203:115-7.
[23] Ludwing E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Br J Dermatol 1977; 97:247-54.
[24] Camacho – Martinez FM. Hair loss in women. Semin Cutan Med Surg 2009; 28:19-32.
[25] Olsen EA. Female pattern hair loss. J Am Acad Dermatol 2001; 45:S70-80.
[26] Kligman AM. Pathologic dynamics of human hair loss. Telogen effluvium. Arch Dermatol 1961; 83:175-98.
[27] Gilmore S, Sinclair R. Chronic telogen effluvium is due to a reduction in the variance of anagen duration. Australas J Dermatol2010; 51:163-7.
[28] De Berker D. Clinical relevance of hair microscopy in alopecia. Clin Exp Dermatol 2002; 27:366-72.
[29] Headington JT Telogen effluvium. New concepts and review. Arch Dermatol 1993; 129:356-63.
[30] Dawber RPR, Simpson NB, Barth JH. Diffuse alopecia: Endocrine, metabolic and chemical influences on the follicular cycle. In: Dawer RP,editor. Diseases of the hair and scalp. Oxford: Blackwell Science; 1997.p.123-50.
[31] Hadshiew IM, Foitzik K, Arck PC, Paus R. Burden of hair loss. Stress and the underestimated psychosocial impact of telogen effluvium and androgeneticalopecia J Invest Dermatol 2004; 123:455-7.
[32] Goette DK, Odom RB. Alopecia in crash dieters. JAMA 1976; 235:2622-3.
[33] Trueb RM. Is androgenetic alopecia a photo aggravated dermatosis. Dermatology 2003; 207:343-8.
[34] Braida D, Dubief C, Lang G. Photo ageing of hair fiber and photo protection. Skin Pharmacol 1994; 7:73-7.
[35] Pierard –Franchimont C, Peerard GE. L’effluvium telogene actinique: Une facette de la chronobiologie humaine. Int J Cosmet Sci 1999; 21:15-21.
[36] Whiting DA, Chronic telogen effluvium: increased scalp hair shedding in middle aged women. J Am Acad Dermatol 1996; 35:899-906.
[37] Messanger AG, de Berker DA, Sinclair RD. Disorders of Hair. In: Burns T, Breathnach S, Cox N, Griffits C, editiors. Rooks textbook of Dermatology. 8th ed. UK: Blackwell Publishing Ltd; 2010.p.66.27-66.
[38] Sinclair R. Diffuse hair loss. Int J Dermatol 1999; 38 (suppl 1):8-18.
[39] Rushton DH, Ramsey ID, James KC, Norris MJ, Gilkes JJ. Biochemical and trichological characterization of diffuse alopecia in women. Br J Dermatol 1990; 123:187-97.
[40] Kaimal S, Thappa DM. Diet in dermatology: Revisited. Indian J Dermatol Venereol Leprol 2010; 76:103-15.
[41] Rushton DH. Nutritional factors and hair loss. Clin Exp Dermatol 2002; 27:396-404.
[42] Dawber RP,Connor BL. Pregnancy, hair loss, and the pill. Br Med J 1971; 4:234.