김도영

Yonsei Medical Journal

Yonsei University Medical Library Open Access Repository

682 www.eymj.orgAnagen effluvium (AE) is the result of a disturbance of prolif-erative activity of hair follicle matrix cells, which leads to the narrowing and subsequent breakage of the proximal portion of hair shafts.1,2 However, abrupt transition from anagen to telo-gen can affect the diameter of newly formed hair shafts in telo-gen effluvium (TE),3,4 therefore, we analyzed the proximal thin-ning of hair shafts at the suprabulbar level in TE. Participants who were diagnosed TE based on the percent-age of telogen hair in trichogram (>20%) were enrolled. Patients who have alopecia areata, scarring alopecia, or very short clipped hair, and those who were using cytotoxic agents were excluded. And chronic TE was defined as a condition with a duration of more than 6 months.Telogen hair samples were collected from participants dur-ing a hair pull test. The telogen club hairs were gently pulled from more than three different areas of scalp. Randomly se-lected shed hairs were laid out on glass slides, aligned at both ends, and secured with transparent adhesive tape. The mor-phology of each proximal hair shaft was examined microscopi-cally, and the diameters were measured across the suprabul-bar levels and mid-shaft levels of hairs (distances of 3–5 cm from the proximal ends of hairs). Data from at least five hairs of each participant were collected. All data were analyzed by ANOVA test using SAS software, version 9.2 (SAS Institute Inc., Cary, NC, USA).A total of 64 participants were enrolled in the study and di-vided into three groups: 21 acute TE patients, 32 chronic TE patients, and 11 healthy controls who had no history of medi-cal or hair disease. Demographics of the study population and calculated data are described in Supplementary Table 1 (only online). The most common conditions associated with TE were medications and systemic illness in both acute and chronic TE. Hair shaft thicknesses along suprabular or mid-shaft level were not statistically different among groups. However, the ra-tio of the diameter along the suprabulbar level to the mid-shaft level in hair shafts was significantly decreased in acute TE group (0.84±0.05) compared with chronic TE (0.89±0.07, p=0.004) and controls (0.94±0.07; p<0.001) in ANOVA (p= 0.003), Tukey’s post-hoc test (Fig. 1). Insults which induce AE can cause abrupt cessation of mi-totic activity of hair follicle matrix cells. It leads to the weaken-ing of proximal hair shafts, thereby resulting in subsequent breakage of the hair shafts.5 However, tapered proximal hair shafts due to premature entry of follicles into telogen can be observed in cytotoxic agent-induced acute effluvium depend-ing on the severity of insult.4 A previous report proposed the term “atrophic TE” to distinguish this condition from conven-tional TE or AE.4 In the present study, however, the tapering of proximal hair bulbs (suprabulbar thinning) was observed even in conventional TE. In TE, the causative follicular insult also impacts anagen follicles in the first instance, after which they enter telogen and hairs are lost as such. The difference in loss induced by cytotoxics is that hair shafts first taper prior to entering telogen.4 In conclusion, suprabulbar thinning in proxi-mal hair can be a common change occurring in acute TE, there-fore, this result suggests that proximal tapering is not a unique event in AE, but both TE and AE can have morphological sim-ilarity. And suprabulbar thinning of proximal hair shaft can happen also in TE, so that it cannot be used to differentiate between AE and TE.ACKNOWLEDGEMENTSThis study was supported by a grant of the Korean Health Tech-nology R&D Project, Ministry of Health & Welfare Republic of Korea (HI14C2357).Suprabulbar Thinning of Hair in Telogen Effluvium Sungsik Shin and Do Young KimDepartment of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.Letter to the EditorpISSN: 0513-5796 · eISSN: 1976-2437Received: October 5, 2015   Revised: December 14, 2015Accepted: December 24, 2015Corresponding author: Dr. Do Young Kim, Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Med-icine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.Tel: 82-2-2228-2080, Fax: 82-2-393-9157, E-mail: dykim@yuhs.ac•The authors have no financial conflicts of interest.© Copyright: Yonsei University College of Medicine 2017This is an Open Access article distributed under the terms of the Creative Com-mons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and repro-duction in any medium, provided the original work is properly cited.Yonsei Med J 2017 May;58(3):682-683https://doi.org/10.3349/ymj.2017.58.3.682683Sungsik Shin and Do Young Kimhttps://doi.org/10.3349/ymj.2017.58.3.682REFERENCES1. Kanwar A, Narang T. Anagen effluvium. Indian J Dermatol Vene-reol Leprol 2013;79:604-12.2. Mubki T, Rudnicka L, Olszewska M, Shapiro J. Evaluation and di-agnosis of the hair loss patient: part I. History and clinical exami-nation. J Am Acad Dermatol 2014;71:415.e1-15. 3. Rebora A. Telogen effluvium. Dermatology 1997;195:209-12.4. Bleiker TO, Nicolaou N, Traulsen J, Hutchinson PE. ‘Atrophic telo-gen effluvium’ from cytotoxic drugs and a randomized controlled trial to investigate the possible protective effect of pretreatment with a topical vitamin D analogue in humans. Br J Dermatol 2005;153:103-12.5. Trüeb RM. Diffuse hair loss. In: Blume-Peytavi U, Whiting DA, Trüeb RM, editors. Hair growth and disorders. Berlin: Springer; 2008. p.259-72.Acute TE Chronic TE ControlNS*****1.21.00.80.6Diameter ratio (suprabular/mid shaft level)Fig. 1. The measurement of diameter along suprabulbar and mid-shaft level in hair shafts. (A) Bulbar portion of a hair and (B) mid-shaft portion of the same hair in a patient with acute TE. (C) Bulbar portion of a hair and (D) mid-shaft portion of the same hair in a healthy control. Significant thinning of the supra-bulbar area of a hair is observed compared to the mid-shaft portion of a hair in acute TE (61.36 μm vs. 83.40 μm). In contrast, control shows similar thick-ness between the suprabulbar and mid-shaft portions of a hair (84.69 μm vs. 85.23 μm) (under 400× magnification). (E) The suprabulbar/mid-shaft level di-ameter ratios of hair in acute/chronic TE and controls. The diameters were measured across the suprabulbar and mid-shaft levels of hairs (about distances of 3–5 cm from the proximal ends of hairs) under a microscope. The ratio of the diameter along the suprabulbar level to the mid-shaft level in hair shafts was significantly decreased in acute TE group (0.84±0.05) compared with chronic TE (0.89±0.07, p=0.004) and controls (0.94±0.07; p<0.001) in ANOVA (p=0.003), Tukey’s post-hoc test. TE, telogen effluvium.ABCD E

Suprabulbar thinning of hair in telogen effluvium

https://ir.ymlib.yonsei.ac.kr/bitstream/22282913/154642/1/T201701020.pdf

Suprabulbar thinning of hair in telogen effluvium

Abstract

Similar works

Full text

Available Versions

Yonsei University Medical Library Open Access Repository