Telogen Effluvium With Dysesthesia (TED) Has Lower B12 Levels and May Respond to B12 Supplementation

November 2018 | Volume 17 | Issue 11 | Features | 1236 | Copyright © November 2018

Theodore Daly MD, Kristin Daly BS

Garden City Dermatology, Garden City, NY

Table3Table4B12 in patients exhibiting psychiatric symptoms, but also found a deficient cerebrospinal fluid level of B12.19-21 Mitsuyama7 reported that in demented patients CSF-B12 levels were low, even when serum B12 levels were between 500-1300 pg/mL. It has also been suggested that disturbances in the group C nerve fibers may be the cause of the scalp dysesthesia, as the sensations of both pain and itch are carried on these nerve fibers.1,18 Psychiatric manifestations may be the first symptoms of spinal degeneration and vitamin B12 deficiency.21Evaluating methylmalonic acid and homocysteine levels is a consideration in the evaluation of B12 deficiency. If these levels are elevated in the presence of a “normal” B12 level, it indicates impaired function of holo-transcobalamin, the active form of vitamin B12, and this may have affected the nine patients in the TED group with B12 levels above 550 pg/mL. Decreased B12 function may also be seen in patients with certain MTHFR gene mutations and further evaluation may be necessary.The results of this study suggest that laboratory evaluation of B12 levels should be done in all patients with TED and supplementation with B12 is recommended to reverse the lower levels and minimize or eliminate theTelogen Effluvium, as well as the associated Dysesthesia, seen in TED.Supplementation with B12 injections and/or orally is recommended, especially in patients with a level below 550 pg/mL.




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Theodore Daly MD