Diffuse hair loss

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An interruption of the normal hair cycle leads to generalised hair loss. This may be due to changes in circulating hormones, drugs, inflammatory skin disease, and "stress" of various types.

Telogen effluvium occurs if all the hairs enter into the resting phase together, most commonly after childbirth or severe illness. Two or three months later the new anagen hair displaces the resting telogen hair, resulting in a disconcerting, but temporary, hair loss from the scalp. Stress of any type, such as an acute illness or an operation, causes a similar type of hair loss.

Postfebrile alopecia occurs when a fever exceeds 39 °C, particularly with recurrent episodes. It has been reported in a wide range of infectious diseases, including glandular fever, influenza, malaria, and brucellosis. It also occurs in fever associated with inflammatory bowel disease.

Dietary factors such as iron deficiency and hypoproteinaemia may play a role, but are rarely the sole cause of diffuse alopecia.

Severe malnutrition with a protein deficiency results in dystrophic changes with a reduction in the rate of hair growth.

Congenital alopecia may occur in some hereditary syndromes.

Anagen effluvium occurs when the normal development of hair and follicle is interfered with, resulting in inadequate growth. As a result, hairs are shed earlier than usual, while still in the anagen phase.

Endocrine causes of diffuse alopecia include both hypo-and hyperthyroidism, hypopituitarism, and diabetes mellitus. In hypothyroidism the hair is thinned and brittle, whereas in hypopituitarism the hair is finer and soft but does not grow adequately.

Systemic drugs—cytotoxic agents, anticoagulants, immunosuppressants, and some antithyroid drugs—may cause diffuse hair loss, usually an "anagen effluvium" as mentioned above.

Inflammatory skin disease, when widespread, can be associated with hair loss, for example in erythroderma due to psoriasis or severe eczema.

Deficiency states are a rare cause of alopecia. Patients who suffer from hair loss are often convinced that there is some deficiency in their diet and may sometimes produce the results of an "analysis" of their hairs which show deficiencies in specific trace elements. In fact it is very difficult to cause actual hair loss even in gross malnutrition and in those dying from starvation in refugee camps, the hair growth in the scalp is usually

Change in environment


Antifungal Antibacterial

Inheritance (genetic)

Family history of - Male pattern alopecia - Alopecia areata

Disease process


ome 1

Response of organism

(immunological, physiological) Induced inflammation Cortico steroid Ultraviolet light

Factors leading to development of alopecia

Diffuse alopecia caused by ciclosporin

Anagen effluvium

Diffuse alopecia caused by ciclosporin

Alopecia Areata Diffuse
Diffuse alopecia caused by erythrodermic psoriasis

present. In chronic malnutrition or kwashiorkor, the hair assumes a curious red/brown colour which may be due to iron deficiency.


Wherever possible, the cause should be treated. This may be a matter of replacement therapy in hormonal deficiency. In alopecia due to stress, once this cause is removed hair growth may revert to normal. Treatment of inflammatory skin disease will result in some improvement of the hair loss.

Androgenic alopecia in men is best accepted, with assurance that it indicates normal virility.

Minoxidil causes hair growth and is commercially available as a lotion. This has to be applied continuously every day as the scalp reverts to a level of loss which would have occurred without treatment as soon as it is stopped. It is effective in about half the patients with male pattern alopecia.

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