title: Non-invasive method distinguishes chronic telogen effluvium from mild female pattern hair loss: clinicopathological correlation.
abstract: BACKGROUND
  The distinction between chronic telogen effluvium (CTE) and female pattern hair loss (FPHL) is important because of their different prognosis and treatment. Non-invasive methods have been described to be useful in differentiating FPHL from CTE. This prospective study investigated the use of the washing method to differentiate CTE from mild FPHL.
  
  
  METHODS
  Twenty patients with CTE and 17 with FPHL were recruited and followed for 18 months. The diagnosis was established through clinical, laboratory, and histological studies. The patients were asked to abstain from washing their hair for 5 days and then shampoo and collect all hair shed in the process. Hair shafts were then counted and divided into two groups: up to 3 cm in length or longer.
  
  
  RESULTS
  In the CTE group, the mean hair count was high (438), and in all cases, <10% were short. In patients with FPHL, the mean count was not as high (215) and in only one patient, short hairs comprised <10% of the total. The greater the number of long hairs, the higher was the density of terminal follicles seen histologically. The CTE group presented a greater number of patients with serum iron values <70 μg/dl. Ferritin levels ranged from 6.98 to 128.33, average of 66.65 (CTE), and 16.5-304.8, average of 114.97 ng/ml (FPHL), but no significant differences were found.
  
  
  CONCLUSIONS
  The washing test can be useful to avoid biopsy procedures. Iron serum levels are possibly an additional parameter that may improve CTE diagnosis if combined with an earlier test.
authors.affiliation: Department of Pathology, Medical School, State University of Campinas, Campinas, Brazil.
authors.forename: Caroline
authors.initials: C
authors.lastname: Bittencourt
authors.affiliation: Department of Dermatology, Ealing Hospital, London, UK.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Teixeira
authors.affiliation: Department of Pathology, Medical School, State University of Campinas, Campinas, Brazil.
authors.forename: Daniela A
authors.initials: DA
authors.lastname: Ferraro
authors.affiliation: Department of Pathology, Medical School, State University of Campinas, Campinas, Brazil.
authors.forename: Tania C B
authors.initials: TC
authors.lastname: Soares
authors.affiliation: Department of Dermatology, Medical School, State University of Campinas, Campinas, Brazil.
authors.forename: Aparecida M
authors.initials: AM
authors.lastname: Moraes
authors.affiliation: Department of Pathology, Medical School, State University of Campinas, Campinas, Brazil.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Cintra
mesh_terms: D000328:Adult; D000368:Aged; D000505:Alopecia / Q000097:blood / Q000175:diagnosis* / Q000473:pathology*; D003937:Diagnosis, Differential; D019937:Diagnostic Techniques and Procedures; D005293:Ferritins / Q000097:blood; D006197:Hair / Q000473:pathology*; D018859:Hair Follicle / Q000473:pathology; D006801:Humans; D007501:Iron / Q000097:blood; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D005293:Ferritins; D007501:Iron