We investigated a subtype of Telogen Effluvium associated with Dysesthesia, (TED) which was defined as the presence of Telogen Effluvium with severe itch, pain, soreness, burning, or formication in the absence of any inflammatory scalp disorder or medication associated with Telogen Effluvium or Dysesthesia. These are patients who present with a “burning” scalp or other dysesthesia associated with increased telogen hair shedding. Telogen Effluvium is not typically associated with any scalp symptoms.3 Other scalp dysesthesia studies have mentioned occasional patients in their study that were also diagnosed with Telogen Effluvium,1,2 but the clinical association of Scalp Dysesthesia and Telogen Effluvium has never been made as a distinct entity.
We describe a subtype of Telogen Effluvium, Telogen Effluvium with Dysesthesia (TED), and describe diagnostic parameters to identify the disease (see Table 1). We also evaluated B12 levels in patients diagnosed with TED and compared these results to patients diagnosed with Telogen Effluvium (without dysesthesia). We then evaluated a second, separate group of 10 new patients diagnosed with TED after B12 treatment.
In this retrospective chart review, we identified patients who complained of significant hair loss and shedding and who also complained of a significant dysesthesia that occurred along with the shedding. A control group of randomly chosen patients with Telogen Effluvium without dysesthesia was also reviewed. All patients had a positive pull test. These results were then statistically evaluated and compared for significance. Patients with TED were evaluated for B12 levels with laboratory tests obtained on the initial visits from January 2013 to September 2016. All patients were evaluated at Garden City Dermatology, a suburban Dermatology practice with an interest in diseases of the hair, located in Garden City, Long Island, NY. All patients from January 2013 through September 2016 with an initial diagnosis of Telogen Effluvium who also complained of scalp dysesthesia were included. Dysesthesia was defined as severe itch, pain, soreness, burning, or formication that occurred in close proximity (immediately prior to), or during, the hair loss (see Table 2). We retrospectively reviewed the patient charts of TED patients for B12 levels to determine if there were any significant abnormalities and compared our findings with a control group of patients diagnosed with only Telogen Effluvium. The control group was randomly chosen from a computer- generated list of patients who were diagnosed with Telogen Effluvium but did not have dysesthesia.We then took a second group of 10 new patients who were diagnosed with TED and prospectively tested for B12. We then treated them with B12 and evaluated the efficacy of this treatment.Data SourcesVitamin B12 levels were evaluated by the lower limit of normal as well as the testing laboratory equivocal levels of 200-400 pg/mL where these levels may be inadequate and cause symptomatology of B12 deficiency. The B-12 laboratory values were then also evaluated for levels below 550 pg/mL, which is a limit that is used in other countries.4 The data was then subdivided into multiple levels for evaluation (see figure 1).Laboratory results were obtained from federally approved commercial laboratories. The TED group and the TE control group were evaluated to determine if the groups were comparable by sex, age race or duration of hair loss (see Table 3). The sample size consisted of forty-five TED cases that were tallied over a 3-year period. All patients had laboratory testing done. An identical number (45) of control Telogen Effluvium patients (without dysesthesia) was used as a comparison for our experimental TED group. In total, we examined 90 patient’s lab results plus an additional 10 patients with TED who were evaluated for treatment response to B12.