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      Deflúvio Telogénico Crónico Translated title: Chronic Telogen Effluvium

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          Abstract

          RESUMO O deflúvio telogénico crónico pode definir-se como uma queda de fios superior à fisiológica (acima de 150-200 fios/dia) por um período superior a seis meses, sem que exista uma causa evidente. Embora comum, é muitas vezes subdiagnosticado, e levanta várias questões de índole prática às quais a literatura tem dificuldade em responder, desde a sua etiopatogénese à terapêutica. Neste artigo da Educação Médica Contínua, pretendemos ajudar a responder a estas questões, revendo a definição, fisiopatologia, caraterísticas clínicas / tricoscópicas / histológicas e a terapêutica do deflúvio telogénico crónico.

          Translated abstract

          ABSTRACT Chronic telogen effluvium can be defined as a hair loss greater than the physiological one (above 150-200 hairs / day) for a period of more than six months, without an evident cause. Although common, it is often underdiagnosed, and raises several questions of a practical nature that the literature still has some difficulties in answering, from its etiopathogenesis to therapy. In this article on Continuing Medical Education, we intend to help answer these questions, reviewing the definition, pathophysiology, clinical / tricoscopic / histological characteristics and the therapy of the chronic telogen effluvium.

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          Most cited references62

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          Telogen Effluvium: A Review.

          Telogen effluvium was first described by Kligman in 1961. It is a most common cause of diffuse hair loss. Women with telogen effluvium more frequently present to dermatologist. A wide variety of potential triggers have been implicated in the pathogenesis of telogen effluvium. Diffuse shedding of telogen hair are seen after 3-4 months of triggering event. The observation of increased telogen hair shedding does not infer a cause. Establishing aetiology of telogen effluvium requires elicitation of relevant history and appropriate laboratory investigations to exclude endocrine, nutritional and autoimmune disorders.
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            Chronic telogen effluvium: increased scalp hair shedding in middle-aged women.

            Diffuse loss of scalp hair is a common problem in middle-aged women. A segment of these cases represents idiopathic chronic telogen effluvium (CTE). The purpose was to establish distinctive clinical and pathologic criteria for the diagnosis of CTE to facilitate its differentiation from androgenetic alopecia (AGA) and systemic causes of chronic diffuse hair loss. A group of 355 patients (346 females, 9 males) with diffuse generalized thinning of scalp hair of unknown origin were classified as having CTE and were included in the study. Characteristically they presented with a history of hair loss with both increased shedding and thinning of abrupt onset and fluctuating course and showed diffuse thinning of hair all over the scalp, frequently accompanied by bitemporal recession. Two 4 mm punch biopsy specimens were taken mostly from the mid or posterior parietal scalp of these patients. The biopsies were performed at these same areas in 412 patients with AGA (193 male, 219 female). Similar paired biopsy specimens were also taken from 22 normal control subjects (13 males, nine females). Specimens were sectioned horizontally and vertically and were examined for terminal and velluslike (miniaturized) hairs, follicular stelae, follicular units, and perifollicular inflammation and fibrosis. In horizontal sections of 4 mm punch biopsy specimens from patients with CTE the average number of hairs was 39, the terminal/velluslike hair ratio was 9:1, 89% of the terminal hairs were in anagen, and 11% were in telogen. In AGA these values were 35, 1.9:1, 83.2%, and 16.8%, respectively, and in normal control subjects 40, 7:1, 93.5%, and 6.5%, respectively. Significant degrees of inflammation and fibrosis were present in only 10% to 12% of cases of CTE and normal controls, but occurred in 37% of cases of AGA. CTE ran a prolonged and fluctuating course in many patients. CTE, which usually affects 30- to 60-year-old women, starts abruptly with or without a recognizable initiating factor. It may be distinguished from classic acute telogen effluvium by its long fluctuating course and from AGA by its clinical and histologic findings.
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              Diet and hair loss: effects of nutrient deficiency and supplement use

              Patients presenting with hair loss should be screened by medical history, dietary history and physical exam for risk factors for nutrient deficiency. If warranted, laboratory studies may be performed. In patients with no risk factors, further laboratory evaluation searching for nutritional deficiencies is not warranted. For patients with nutritional deficiencies, it is clear that those deficiencies should be corrected. Further research is required to determine whether any benefit exists for nutrient supplementation in the absence of documented deficiency. At this time, patients must be informed that such research is lacking and that in fact some supplements carry the risk of worsening hair loss or the risk of toxicity.
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                Author and article information

                Journal
                rspdv
                Revista da Sociedade Portuguesa de Dermatologia e Venereologia
                Rev Soc Port Dermatol Venereol
                Sociedade Portuguesa de Dermatologia e Venereologia (Lisboa, , Portugal )
                2182-2395
                2182-2409
                December 2020
                : 78
                : 4
                : 3-11
                Affiliations
                [2] Lisboa orgnameHospital Cuf Descobertas orgdiv1Serviço de Dermatologia Portugal
                [1] Coimbra orgnameCentro Hospitalar e Universitário de Coimbra orgdiv1Serviço de Dermatologia Portugal
                Article
                S2182-23952020000400003 S2182-2395(20)07800400003
                10.29021/spdv.78.4.1254
                fcb908af-dd69-4b13-be15-c11ad8a74acf

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 28 September 2020
                : 18 July 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 64, Pages: 9
                Product

                SciELO Portugal

                Categories
                Educação Médica Contínua

                Hair Follicle.,Folículo Piloso.,Alopecia,Hair Diseases,Doenças do Cabelo,Alopécia

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