Diagnostic Considerations
Also consider the following:
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Hypothyroidism
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Hyperthyroidism
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Hypopituitarism
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Diabetes mellitus
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Sézary syndrome
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Lymphoma
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Protein malnutrition
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Iron deficiency
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Collagen disease
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Endocrine and metabolic disorders
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Infections (eg, syphilis)
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Widespread skin disease
Because most scalp hair is in anagen at a given time, and telogen effluvium is dependent on the transition from anagen to telogen, with subsequent release of telogen hairs, it has a latent period of months, and the hair loss is usually subclinical, involving less than 50% of hairs. [2]
Reversible alopecia following chemotherapy is common. However, permanent chemotherapy-induced alopecia, has been described, with a unique histologic finding of replacement of anagen hair follicles by linear columns of basaloid epithelium. [21] Although anagen effluvium due to chemotherapy is usually reversible with complete hair regrowth, certain chemotherapy regimens can cause dose-dependent permanent alopecia with histological features of nonscarring alopecia similar to androgenetic alopecia. [22]
Profuse hair shedding may reveal anagen hair dystrophy, representing a diagnostic clue of incipient alopecia areata. [23]
Hair disorders with autoimmune connective-tissue diseases may uncommonly resemble anagen effluvium. [24]
Differential Diagnoses
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Androgenetic Alopecia
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Anagen effluvium. Courtesy of DermNet New Zealand (https://www.dermnetnz.org/assets/Uploads/hair-nails-sweat/anagen-effluvium-01.jpg).