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LETTER TO THE EDITOR
Postpartum telogen effluvium
Sir,
We read the article of Gizlenti and Ekmekci on the changes
in the hair cycle during the postpartum period1 with great
interest. We had a similar experience and we congratulate
with our Turkish colleagues for keeping so many pregnant
women under so long a study. Pregnant women are not an
easy group of subjects to study and, in our practice, the
cases that drop out are so numerous as to jeopardize the
realization of the study itself.
We emphasize, however, that observing a high percentage of
telogen hairs does not mean getting an assessment of the preva-
lence of clinical cases of telogen effluvium (TE). In other words,
the increase in the telogen/anagen ratio at the 4th month after
delivery, observed by Gizlenti and Ekmekci, does not necessarily
mean that those women complained of a clinically significant
hair shedding identifiable as TE and capable of leading them to
the specialist. In our modest experience, only four of 20 cases
registered a clinically manifest TE, numbering, as assessed by the
Modified Wash Test,2 from 113 to 1824 hairs. The latter figure
was so impressive that the technician took 3 days to finish
counting. It should be noted, however, that the same subject
shed 283 hairs at the 7th month of pregnancy. Hence, as per our
standards, she had already TE. A modest increase of shed telogen
hairs was noted in 10 other cases, but it was not enough for them
to complain of TE and, for us, to catalogue it as TE.
Taking into due account the difference between the two meth-
ods adopted, we agree with Gizlenti and Ekmekci that an
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increase of telogen hairs occurs in a large proportion of women
after delivery, but that only in a minority of them (about 20%)
such an increase is so high as to result in a clinically relevant hair
shedding. The reasons why this phenomenon occurs are still to
be clarified. Probably, postpartum TE is not a physiological phe-
nomenon as it does not occur in all women nor in all the preg-
nancies of the same woman, but it may be the result of two
concurrent mechanisms: the synchronization of the hair cycles
during pregnancy and a premature entry into telogen probably
related to the emotional stress of the delivery,3 which, in fact, is
usually the first delivery when the emotional involvement is
highest.
A. Rebora,* M. Guarrera, F. Drago
University of Genoa, Genoa, Italy
*Correspondence: A. Rebora. E-mail: rebdermo@unige.it
References
1 Gizlenti S, Ekmekci TR. The changes in the hair cycle during gesta-
tion and the post-partum period. J Eur Acad Dermatol Venereol 2014;
28: 878–881.
2 Rebora A, Guarrera M, Baldari M, Vecchio F Distinguishing androgenetic
alopecia from chronic telogen effluvium when associated in the same
patient: a simple noninvasive method. Arch Dermatol 2005; 141:
1243–1245.
3 Rebora A. Telogen effluvium revisited. G Ital Dermatol Venereol 2014; 149:
47–54.
DOI: 10.1111/jdv.12914
© 2015 European Academy of Dermatology and Venereology