The Postpartum Telogen Effluvium Fallacy

Postpartum Telogen Effluvium Unmasking Additional Latent Hair Loss Disorders

Obejctive

We sought to detect additional underlying hair loss disorders in patients with postpartum telogen effluvium.

Methods

We completed clinical and dermoscopic evaluations on 200 female participants experiencing postpartum hair loss.

Results

9.5 percent of patients were diagnosed with telogen effluvium (TE), 56.0 percent patients were diagnosed with TE with androgenetic alopecia (AGA), 6.5 percent patients were diagnosed with TE and TA, and 28.0 percent patients were diagnosed with TE, AGA, and TA. In the central area, patients with TE displayed upright regrowing hair and single pilosebaceous unit in 100 percent and 94.7 percent of patients, respectively. While patients with TE and AGA, displayed upright regrowing hair, single pilosebaceous unit, and hair diameter diversity greater than 20 percent. In patients diagnosed with TE and TA, the trichoscopic findings were similar in the TE group to the patients diagnosed with TE, AGA, and TA were also similar to the patients with TE and AGA. Regarding the area of traction, there was no difference observed between the patients with TE and TA and patients with TE, AGA, and TA. The frequent findings were hair diameter diversity, empty follicles, and vellus hair.

Conclusion

Postpartum TE may be associated with other hair loss disorders. Awareness of this is critical to appropriate diagnosis and treatment.

Investigation of exacerbating factors for postpartum hair loss: a questionnaire-based cross-sectional study

Background

Although postpartum hair loss is believed to be common, there is little reliable information.

Objective

We sought to examine the factors that were associated with postpartum hair loss and to elucidate factors correlated with its pathogenesis.

Methods

We carried out a questionnaire-based cross-sectional study. The study participants were women who delivered at 2 facilities and filled the questionnaire 10-18 months after delivery. The survey questionnaire included baseline characteristics, pregnancy details, delivery, childcare, and extent of postpartum hair loss. We divided participants into 2 groups according to the absence or presence of postpartum hair loss and performed logistic regression analyses.

Results

A total of 331 (21.0%) responses were analyzed; among these 304 (91.8%) women had postpartum hair loss. The average time for the start, peak, and end of hair loss was 2.9, 5.1, and 8.1 months, respectively. Women with hair loss had an earlier time of delivery, a lower birth weight, a higher preterm labor rate, and longer-term breastfeeding. Logistical regression analyses revealed that longer-term breastfeeding and preterm labor were independent predictors of postpartum hair loss. The adjusted odds ratio for postpartum hair loss in women who ended breastfeeding 6-12 months postpartum versus those who ended it after 12 months or more was 5.96 (95% confidence interval [CI] [1.68, 21.09]) and 6.37 (95% CI [1.95, 20.76]) compared with those who stopped breastfeeding within 6 months postpartum.

Limitations

Finer details such as pregnancy complications and delivery information may not be accurate since all results are based on questionnaire responses. There may be a sampling bias because women who suffer from postpartum hair loss may tend to participate more frequently.

Conclusion

Over 90% of women experienced postpartum hair loss. Our data show that long-term breastfeeding and preterm labor correlate with postpartum hair loss.

Investigation of menopause-induced changes on hair by Raman spectroscopy and chemometrics

The ending of estrogen production in the ovaries after menopause results in a series of important physiologic changes, including hair texture and growth. In this study we demonstrate that Raman spectroscopy can be used successfully as a tool to probe menopause-induced changes on hair, in particular when coupled with suitable chemometrics approaches. The detailed analysis of the average Raman spectra (in particular of the Amide I and νS-S stretching spectral regions) of the hair samples of women pre- and post-menopause allowed to estimate that absence of estrogen in post-menopause women leads to an average reduction of ∼12% in the thickness of the hair cuticle, compared to that of pre-menopause women, and revealed the strong prevalence of disulphide bonds in the most stable gauche-gauche-gauche conformation in the hair cuticle. From the analysis of the νS-S stretching spectral region it could also be concluded that the amount of α-helix keratin is slightly higher for post-menopause than for pre-menopause women. A series of statistical models were developed in order to classify the hair samples. Outperforming the traditional PCA-LDA (principal component analysis - linear discriminant analysis) approach, in the present study a GA-LDA (genetic algorithm - linear discriminant analysis) strategy was used for variable reduction/selection and samples' classification. This strategy allowed to develop of a statistical model (L16), which has exceptional prediction capability (total accuracy of 96.6%, with excellent sensitivity and selectivity) and can be used as an efficient instrument for the hair samples' classification. In addition, a new chemometrics approach is here presented, which allows to overcome the intrinsic limitations of the GA algorithm and that can be used to develop statistical models that use GA as the variable reduction/selection method, but superseding its stochastic nature. Three suitable models for classification of the hair samples according to the menopause status of the women were developed using this novel approach (LV17, BLV20 and PLS7 models), which are based on the Fisher's and Bayers' LDA approaches and the PLS-DA method. The followed new chemometrics approach uses the results of a large set of GA-LDA runs over the full data matrix for the selection of the reduced data matrices. The criterion for the selection of the variables is their statistical significance in terms of number of occurrences as solutions of the whole set of GA-LDA runs.

Types and Treatment of Hair Loss in Men and Women

In this article, the author focuses on 4 common hair loss disorders that occur in both men and women. The author discusses research related to androgenetic alopecia, telogen effluvium, alopecia areata, and scarring alopecia and provides details on how to approach and manage these diseases according to patient gender. There are a range of tools and tests that can assist with the diagnostic process and help ensure that relevant and high standards of patient care are maintained. In some cases, no medical intervention is always a treatment option. However, appropriate medical treatments, although still relatively limited in some cases, are safe and have proven efficacy. Hair loss has immense emotional and psychological impact in both genders, and it is always important to consider this when planning hair loss management pathways.

Types and Treatment of Hair Loss in Men and Women

In this article, the author focuses on 4 common hair loss disorders that occur in both men and women. The author discusses research related to androgenetic alopecia, telogen effluvium, alopecia areata, and scarring alopecia and provides details on how to approach and manage these diseases according to patient gender. There are a range of tools and tests that can assist with the diagnostic process and help ensure that relevant and high standards of patient care are maintained. In some cases, no medical intervention is always a treatment option. However, appropriate medical treatments, although still relatively limited in some cases, are safe and have proven efficacy. Hair loss has immense emotional and psychological impact in both genders, and it is always important to consider this when planning hair loss management pathways.

Hormonal Effects on Hair Follicles

The hair cycle and hair follicle structure are highly affected by various hormones. Androgens—such as testosterone (T); dihydrotestosterone (DHT); and their prohormones, dehydroepiandrosterone sulfate (DHEAS) and androstendione (A)—are the key factors in terminal hair growth. They act on sex-specific areas of the body, converting small, straight, fair vellus hairs into larger darker terminal hairs. They bind to intracellular androgen receptors in the dermal papilla cells of the hair follicle. The majority of hair follicles also require the intracellular enzyme 5-alpha reductase to convert testosterone into DHT. Apart from androgens, the role of other hormones is also currently being researched—e.g., estradiol can significantly alter the hair follicle growth and cycle by binding to estrogen receptors and influencing aromatase activity, which is responsible for converting androgen into estrogen (E2). Progesterone, at the level of the hair follicle, decreases the conversion of testosterone into DHT. The influence of prolactin (PRL) on hair growth has also been intensively investigated, and PRL and PRL receptors were detected in human scalp skin. Our review includes results from many analyses and provides a comprehensive up-to-date understanding of the subject of the effects of hormonal changes on the hair follicle.