What is the role of hair collection in the workup of telogen effluvium?

Updated: Jun 13, 2018
  • Author: Elizabeth CW Hughes, MD; Chief Editor: Dirk M Elston, MD  more...
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If a patient is unwilling to undergo a scalp biopsy but would like confirmation of the diagnosis, serial hair collections may be obtained. This process can educate the patient in the normal hair cycle and can confirm the spontaneous resolution of the process.

The patient should be instructed to collect all hairs shed in a 24-hour period. The patient should not shampoo the hair during the day of collection. This process should be repeated every week or every other week, for a total of 3 or 4 collections.

Collections totaling 100 hairs or more in a given 24-hour period are indicative of ongoing telogen effluvium. If the collections are performed over several weeks while the telogen effluvium is resolving, the number of hairs collected each time should decrease. This finding can be very comforting to the patient.

An alternate method of hair collection has been proposed by Rebora et al. According to this method, the patient collects hair during shampooing and the physician both counts and measures the length of these hairs. This method has the advantage of being able to detect and differentiate between telogen effluvium and androgenetic alopecia, even when the 2 conditions occur in the same individual. [25] The disadvantage to this method is that it cannot be used in patients who have short hair (< 3 cm). Additionally, the counting and measuring procedure is very labor intensive, which limits its practicality in normal clinical practice.

Ross et al report on the successful use of videodermoscopy in the diagnosis of hair and scalp disorders. [26] The color-transition sign has been used to differentiate alopecia areata from telogen effluvium. [28]

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