Causes of diffuse alopecia in women

Abstract

Fifty female patients ranging in age between 14-45 years, complaining of a diffuse loss of hair for periods varying from 1-22 months were thoroughly interrogated to look for the factors leading to the hair loss. Laboratory investigations undertaken included a routine estimation of haemoglobin, ESR, urinalysis, examination of the stools, and any other test indicated by the history or examination. The hair loss was quantitated by asking the patient to collect all the fallen hairs during a 24 hours period for 7 consecutive days, and pack them into appropriately labelled polythene bags. Each collection was weighed to calculated the average daily loss. Such collections were repeated once a month for a period of 4-5 months to monitor the variations in the hair loss and study the effect for treatment. Ten hairs randomly picked from each collection were examined microscopically to look for any shaft abnormalities in addition to the examination of the root end and the distal end. The probable causes of hair loss in these patients were found to be psychologic stress in 21 cases, fever in 11 cases, child-birth/abortion in 5 cases, and a surgical operation in 3 cases. Some of these cases had more than one factor, while in 15 cases there was no clinical evidence of any of the known causes of hair loss. Routine laboratory investigations however revealed a haemoglobin level of less than 12 gm% in 25 cases, an ESR higher than 20 mm in 18 cases, asymptomatic urinary tract infection in 13 cases and gastro-intestinal parasites in stools in 12 cases. Thus every patient had at least one of the causative factors, while several patients had more than one factor which could be responsible for the hair loss. Almost all the cases in this group seemed to have telogen effluvium. Examination of the root end in most of the hairs showed a club hair, while the hair shaft revealed trichorrhexis in some of the hairs in 10 cases and trichoptilosis in 3 cases. Appropriate treatment normalised the hair loss which reflected in the collections of the fallen hair.