Chronic Telogen Effluvium (CTE)
What is CTE?
CTE is often confused with female pattern hair loss and most commonly occurs in women in their 30s. The onset is usually sudden and there is an abrupt increase in the amount of hairs shed in a day up to 100 hairs, and these shed hairs usually have a white bulb. Hairs may shed while combing, brushing or washing the hair.
The amount of hairs shed in a day tends to fluctuate and CTE can last for years before it ultimately stops. Eventhough hair shedding continues for a number of years, the hair loss is only noticable to those affected and persons very close to them. Sometimes, even their hairdressers are not aware of any hair loss. A reliable way to check if you have been shedding excessive hair is to look at the volume of your ponytail, which may be only 30-50% of normal.
The good news about CTE is that there is no problem with the production of hair although there is excessive hair shedding – so that means you would not go bald with CTE, although the volume of your hair could be much less than before.
What causes CTE?
There are a number of triggers including iron deficiency anaemia, childbirth, major illness, crash diet, starting or stopping certain medications, major life stress, etc. However, in most women, no cause is identified.
CTE is not caused by hormones or genetics.
What investigations are required to diagnose CTE?
It is important to have some blood tests done via your doctor – iron studies and thyroid function, as well as reviewing the medications you are taking. If all these investigations are normal, a scalp biopsy may be required to distinguish CTE from female pattern hair loss (FPHL).
Sometimes, CTE can progress to FPHL or they can co-exist. Hence, scalp biopsy may need to be repeated every year or two to confirm diagnosis as management differ between the two conditions.
How do you treat CTE?
As CTE is not caused by hormones, it does not respond to hormonal treatment. There is not effective treatment for CTE although minoxidil lotion (Regaine/Rogaine) could be trialled for three months and this may sometimes stop the hair sheddine.
Treating pre-existing conditions like iron deficiency or thyroid problems are necessary in case they are the underlying causes for CTE.
Lichen planopilaris (LPP)
What is LPP?
Lichen planus is a condition that can affect the skin, the mouth, the hair, and the nails. When it affects the hair, it is called lichen planopilaris. LPP can occur without any skin or nail involvement – in these cases, diagnosis can be difficult.
In LPP, the inflammation in the scalp destroys the hair bulbs. This means that once hairs are lost, there is no potential for regrowth. Once LPP develops, it is difficultto predict what will happen over time without treatment. In general, the area affected by LPP that goes untreated would progress and enlarge up to a point where the condition burns out and spontaneously stops. No one knows why this happens and when LPP burns out, it does not continue to extend.
If lichen planus affects the skin elsewhere, it generally appears as either multiple tiny pin head-sized red lumps on the skin or as red bumps, particularly on the front of the wrists and the shins. If it affects the nails, it can produce thinning or roughening of the nails. If it affects the mouth, it can produce white areas that may be sore.
LPP is not contagious and does not predispose to cancer.
What causes LPP?
The cause of LPP is unknown. While certain drugs can cause lichen planus on the skin, it is not known if they can also cause it on the scalp. When a drug is the cause for lichen planus on the skin, it may only occur two or three years after starting the medication. Whether changing your medications will help LPP is not known.
LPP is not caused by hormones or genetics, and no triggers have been identified.
How is LPP diagnosed?
A scalp biopsy is always required to confirm the diagnosis. However, sometimes biopsies are not always conclusive and hence the diagnosis is not always able to be conclusively established.
What are the treatments available for LPP?
It is not easy to control the inflammation in LPP and there is no single effective medication suitable for everyone. It is common to have to try a few different medications before finding one that is effective.
Although it is not possible to stop the inflammation in everyone, a fair proportion of people experience some success with treatment. It is hard to predict who will benefit from treatment.