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Diffuse Alopecia

Diffuse Alopecia

Diffuse alopecia is a type of hair loss that does not result in complete baldness. Generally, with diffuse alopecia, hair become dull and scattered, thus giving the hair a sparse looks. Diffuse alopecia can be caused by many factors including: hormones, such as hyperthyroidism during or after childbirth; drugs, such as during chemotherapy, nutritional deficiencies, a poor diet or poor absorption of nutrients, stress or nervous shock.

In general, diffuse alopecia is more frequent in the elderly.

Possible causes include:

  • Bulimia or Anorexia Nervosa.
  • Low serum ferritin, serum iron or vitamin B12.
  • Hyper / hypo thyroidism.
  • Post fever (body temperature of 102.5 °F or above).


Physiologic stress

Physiologic stress such as surgical trauma, high fever, chronic systemic illness, and hemorrhage are well known to cause telogen effluvium 2 to 3 months after the insult. Telogen hair shedding can be experienced 2 to 4 months after childbirth (telogen gravidarum).

Emotional stress

The relationship between emotional stress and hair loss is difficult to ascertain, and hair loss itself is stressful to the patient. Historically, acute reversible hair loss occurring with great stress has been reported. However, the relationship between chronic diffuse hair loss and psychological stress is controversial. Evidence for this association appears to be weak, as everyday stresses are likely not enough to trigger hair loss.

Medical conditions

Both hypothyroidism and hyperthyroidism can cause diffuse telogen hair loss that is usually reversible once the euthyroid state is restored. Chronic systemic disorders such as systemic amyloidosis, hepatic failure, chronic renal failure,inflammatory bowel disease, and lymphoproliferative disorders can cause telogen hair shedding. Telogen hair loss has also been reported in autoimmune diseases such as systemic lupus erythematosus and dermatomyositis, as well as in chronic infections such as human immunodeficiency virus type 1 and secondary syphilis. Inflammatory disorders such as psoriasis, seborrheic dermatitis, and allergic contact dermatitis can all cause diffuse telogen hair loss.

Dietary triggers

Nutritional causes of diffuse telogen hair loss are zinc deficiency and iron deficiency. Severe protein, fatty acid and caloric restriction with chronic starvation and crash dieting can also induce diffuse telogen hair loss. Malabsorption syndromes and pancreatic disease can precipitate telogen hair shedding. Essential fatty acid deficiency can also be associated with diffuse telogen hair shedding usually 2 to 4 months after inadequate intake. Vitamin D is an essential vitamin in cell growth, and vitamin D deficiency may be associated with diffuse hair loss. Biotin deficiency can result in alopecia, but this is a very rare cause of hair loss.

Drugs that cause hair loss

Drugs can cause telogen hair loss that starts about 12 weeks after starting the drug and continues while on the drug. Dosing changes can also precipitate hair shedding. Any medication or over-the-counter product the patient is taking should be suspected in hair loss.

Drugs known to cause telogen effluvium are oral contraceptive pills, androgens, retinoids, beta-blockers, angiotensin-converting enzyme inhibitors, anticonvulsants, antidepressants, and the anticoagulants heparin and warfarin (Coumadin). Changing or stopping any oral contraceptive can precipitate telogen hair shedding. Oral contraceptives containing an androgenic progestin and hormonal replacement therapy with high-dose progesterone can cause telogen hair shedding with or without patterned alopecia.


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