Analysis of Microscopic Examination of Pulled Out Hair in Telogen Effluvium Patients

BACKGROUND: Telogen effluvium (TE) is characterized by massive hair shedding and results from an abrupt conversion of anagen to telogen. Differentiation of TE with other hair disorders showing massive hair shedding is difficult. OBJECTIVE: To evaluate the morphologic characteristics of pulled out hair of TE. METHODS: We analyzed microscopic examination of pulled out hairs by hair pull test in TE patients, and compared these hairs with pulled out hairs in diffuse alopecia areata (AA) patients and healthy volunteers. RESULTS: Hair microscopic examination in 44 TE patients (370 hairs) and 30 healthy volunteers (295 hairs) were as follows: typical club hair, 32.7%, 62.7%; club hair with tail, 23.5%, 23.7%; club hair with remnant sheath, 23.0%, 6.8%; club hair with both tail and remnant sheath, 18.9%, 5.4%; and unclassified hair, 1.9%, 1.4%. The examination in 7 diffuse AA patients (63 hairs) was as follows: typical club hair, 23.9%; atypical club hair, 47.7%; and distinctive AA hair, 28.4%. There was statistical difference between TE patients and healthy volunteers group (p=0.000). CONCLUSION: Increased atypical club hair in microscopic hair examination might be characteristics of TE.