Telogen effluvium in Child
Drugs implicated include acitretin, isotretinoin, high-dose vitamin A, metoprolol and beta-blockers, bromocriptine, captopril, carbimazole, anticoagulants, cimetidine, fluoxetine, sulfasalazine, valproic acid, interferons, antihyperlipidemic drugs, diabetic drugs, and chemotherapeutic agents. Drug-induced hair loss is usually reversible after interruption of treatment. Recently, two cases have been identified after human papilloma virus (HPV) vaccination in children.
The interval between the inciting event or exposure and the shedding is generally weeks to a few months. In adults, the cause is often never identified. In children, etiology may be easier to discern.
Patients present complaining of a sudden increase in hair shedding from the root with a small white hair bulb, often after showering or during combing. The hair loss occurs uniformly over the entire scalp and is usually asymptomatic, without stinging or pruritus. Hair loss usually exceeds 150 hairs daily and may continue for 6-12 months. Less commonly, a chronic form of telogen effluvium can last several years.
Telogen effluvium itself is a benign and self-limited condition, although its presence may provide a clue to an underlying disease.
L65.0 – Telogen effluvium
39479004 – Telogen effluvium
- Androgenetic alopecia (male or female pattern) – Does occur in early adolescence but is more patterned, ie, on vertex and bitemporally.
- Alopecia areata – Rarely can be generalized; exclamation point hairs can be found.
- Trichotillomania and traction alopecia have irregular patterns.
- Tinea capitis (black dot disease) from Trichophyton tonsurans – Culture is necessary; scaling will be present.
- Secondary syphilis and other infectious febrile diseases
- Medication-induced alopecia
- Anagen effluvium – Seen on hair pull; seen with chemotherapy.
- Anorexia nervosa