A Study of Non-Scarring Diffuse Alopecia

Abstract

Paucity of reports on non-scarring diffuse alopecia in women from this part of the world led us to take up this study. We examined 200 consecutive cases of non-scarring diffuse alopecia in women who attended the skin OPD of a tertiary level urban hospital to find out the different types of diffuse hair loss, their clinical profile, key diagnostic features and etiological factors associated with them. Chronic telogen effluvium (CTE), female pattern hair loss (FPHL) and telogen effluvium (TE) were found to be the most common types of diffuse hair loss, seen in 71 (35.5%), 70 (35%) and 46 (23%) patients, out of a total of 200. These three (CTE, FPHL and TE) together accounted for 93.5% (187/200) of total cases of non-scarring diffuse alopecia in women. Excessive, alarming, diffuse shedding coming from a normal-looking head with plenty of hair
and without an obvious cause was the hallmark of CTE. FPHL was presented as gradual diffuse hair loss with thinning of central scalp and intact hair line (Ludwig type), widening of central parting line with or without a Christmas tree pattern (Olsen type), or as fronto-temporal/bi-temporal recession with or without loss at vertex (Hamilton type/Male type). An abrupt onset and rapid, diffuse, excessive shedding of normal club hair, usually seen 2–3 months after a triggering event was the typical presentation of TE cases. High fever, postpartum hemorrhage and emotional stress were the common triggers associated with TE. Abnormal thyroid functions (23/200, 11.50%) and anemia (78/200, 39%) were noted in a significant number of cases of diffuse hair loss, making it mandatory to investigate them in all cases of diffuse hair loss.