Ann Dermatol.  2020 Apr;32(2):141-145. 10.5021/ad.2020.32.2.141.

Analysis of Microscopic Examination of Pulled Out Hair in Telogen Effluvium Patients

  • 1Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.


Telogen effluvium (TE) is characterized by massive hair shedding and results from an abrupt conversion of anagen to telogen. Differentiation of TE with other hair disorders showing massive hair shedding is difficult.
To evaluate the morphologic characteristics of pulled out hair of TE.
We analyzed microscopic examination of pulled out hairs by hair pull test in TE patients, and compared these hairs with pulled out hairs in diffuse alopecia areata (AA) patients and healthy volunteers.
Hair microscopic examination in 44 TE patients (370 hairs) and 30 healthy volunteers (295 hairs) were as follows: typical club hair, 32.7%, 62.7%; club hair with tail, 23.5%, 23.7%; club hair with remnant sheath, 23.0%, 6.8%; club hair with both tail and remnant sheath, 18.9%, 5.4%; and unclassified hair, 1.9%, 1.4%. The examination in 7 diffuse AA patients (63 hairs) was as follows: typical club hair, 23.9%; atypical club hair, 47.7%; and distinctive AA hair, 28.4%. There was statistical difference between TE patients and healthy volunteers group (p=0.000).
Increased atypical club hair in microscopic hair examination might be characteristics of TE.


Alopecia; Alopecia areata; Hair

MeSH Terms

Alopecia Areata
Healthy Volunteers


  • Fig. 1 Pulled out hairs were classified microscopically by morphology into typical club hair (A), club hair with tail (B), club hair with remnant sheath (C), and club hair with both tail and remnant sheath (D) (A~D: ×40).

  • Fig. 2 Distinctive AA hairs include hair with tapering of proximal hair shaft (A), hair with breakage of proximal hair shaft (B) and hair with surface undulation (C) (A~C: ×40).

  • Fig. 3 Analysis of morphologic characteristics of pulled out hairs between 3 groups of telogen effluvium patients, diffuse alopecia areata patients, and healthy volunteers (*p<0.05). Distinctive AA hairs were excluded in this analysis. TE: telogen effluvium, AA: alopecia areata.


1. Grover C, Khurana A. Telogen effluvium. Indian J Dermatol Venereol Leprol. 2013; 79:591–603. PMID: 23974577.
2. Shapiro J. Clinical practice. Hair loss in women. N Engl J Med. 2007; 357:1620–1630. PMID: 17942874.
3. Mubki T, Rudnicka L, Olszewska M, Shapiro J. Evaluation and diagnosis of the hair loss patient: part I. History and clinical examination. J Am Acad Dermatol. 2014; 71:415.e1–415.e15. PMID: 25128118.
4. McDonald KA, Shelley AJ, Colantonio S, Beecker J. Hair pull test: evidence-based update and revision of guidelines. J Am Acad Dermatol. 2017; 76:472–477. PMID: 28010890.
5. Hillmann K, Blume-Peytavi U. Diagnosis of hair disorders. Semin Cutan Med Surg. 2009; 28:33–38. PMID: 19341940.
6. Shapiro J, Wiseman M, Lui H. Practical management of hair loss. Can Fam Physician. 2000; 46:1469–1477. PMID: 10925761.
7. McElwee KJ, Sinclair R. Hair physiology and its disorders. Drug Discov Today Dis Mech. 2008; 5:e163–e171.
8. Hardy MH. The secret life of the hair follicle. Trends Genet. 1992; 8:55–61. PMID: 1566372.
9. Jackson AJ, Price VH. How to diagnose hair loss. Dermatol Clin. 2013; 31:21–28. PMID: 23159173.
10. Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update: part I. Clinical picture, histopathology, and pathogenesis. J Am Acad Dermatol. 2010; 62:177–188. quiz 189–190. PMID: 20115945.
11. Otberg N. Primary cicatricial alopecias. Dermatol Clin. 2013; 31:155–166. PMID: 23159184.
12. Van Neste D, Leroy T, Conil S. Exogen hair characterization in human scalp. Skin Res Technol. 2007; 13:436–443. PMID: 17908196.
13. Hoffmann R. TrichoScan: combining epiluminescence microscopy with digital image analysis for the measurement of hair growth in vivo. Eur J Dermatol. 2001; 11:362–368. PMID: 11399546.
14. Piérard GE, Piérard-Franchimont C, Marks R, Elsner P. EEMCO group (European Expert Group on Efficacy Measurement of Cosmetics and other Topical Products). EEMCO guidance for the assessment of hair shedding and alopecia. Skin Pharmacol Physiol. 2004; 17:98–110. PMID: 14976387.
15. Van Neste MD. Assessment of hair loss: clinical relevance of hair growth evaluation methods. Clin Exp Dermatol. 2002; 27:358–365. PMID: 12190635.
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