A 28-year-old woman experiences diffuse hair loss 3 months after delivering a baby. The hair loss is non-scarring and diffuse. Trichoscopy shows increased proportion of telogen hairs with empty follicular ostia. The diagnosis is telogen effluvium. Which underlying condition, if present concomitantly, would most commonly perpetuate the hair loss beyond the expected 3–6 month self-limited course?

• A Polycystic ovarian syndrome
• B Androgenetic alopecia exacerbated by the hormonal shift postpartum
• C Iron deficiency anaemia (ferritin <30 µg/L) ✓
• D Zinc deficiency

Explanation

Postpartum telogen effluvium is typically self-limiting (3–6 months), resolving as follicles re-enter anagen. However, iron deficiency (low ferritin <30 µg/L, even without frank anaemia) is the most common identifiable perpetuating factor in chronic diffuse TE in women, particularly postpartum. Ferritin is needed for ribonucleotide reductase function in rapidly dividing hair matrix cells. Correcting iron deficiency with supplementation is essential to allow hair recovery. While androgenetic alopecia and thyroid disease should also be excluded, iron deficiency has the strongest evidence base as the perpetuating factor in postpartum TE.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.