A 30-year-old woman presents with diffuse non-scarring hair loss 3 months after delivery of her second child. Pull test is positive from multiple sites. Trichoscopy shows increased proportion of telogen hairs (club hairs). The percentage of hairs in telogen that is diagnostic of telogen effluvium on trichoscopy/trichogram is:
- A >10% telogen hairs
- B >25% telogen hairs (>25% club hairs on trichogram) ✓
- C >20% telogen hairs
- D >50% telogen hairs
Explanation
Telogen effluvium is diagnosed on trichogram when >25% of hairs are in the telogen phase (club hairs with white bulbs). Normally, the telogen:anagen ratio is <20% (80-85% anagen, <15% telogen, <1% catagen in scalp). Postpartum telogen effluvium results from synchronization of hairs into telogen during pregnancy (elevated estrogen prolongs anagen), followed by massive telogen shedding 2-4 months after delivery. Trichoscopy shows empty follicular openings, perifollicular discoloration, and yellow dots. Pull test is positive (>5 hairs per pull = positive). Complete recovery is expected within 6-12 months; no specific treatment is required beyond reassurance.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.