Chronic hair shedding

A 45-year-old woman noted increased hair shedding that had developed over a four-year period. This had resulted in a 50% diffuse decrease in the density of the hair over her scalp, but it had not led to recession of her hairline or localised or patterned alopecia (Figure 1). Methodical collecting of the shed hair by the patient on a daily basis revealed a fluctuating degree of hair fall (Figure 2). Examination of these hairs revealed that they were all telogen clubs. The patient had no history of chronic illness and was not on any medications. The results of investigations, including a full blood count, iron levels, thyroid function and hormone levels, were normal.