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Year : 2020  |  Volume : 11  |  Issue : 3  |  Page : 444-445  

Pigtail hair in acute telogen effluvium – Lest we forget!

Department of Dermatology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India

Date of Submission15-Sep-2019
Date of Decision25-Nov-2019
Date of Acceptance26-Nov-2019
Date of Web Publication10-May-2020

Correspondence Address:
Aseem Sharma
OPD 16, Department of Dermatology, LTM General Hospital, Sion, Mumbai, Maharashtra - 400 022
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/idoj.IDOJ_399_19

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How to cite this article:
Dhurat RS, Agrawal S, Sharma A, Ghate S. Pigtail hair in acute telogen effluvium – Lest we forget!. Indian Dermatol Online J 2020;11:444-5

How to cite this URL:
Dhurat RS, Agrawal S, Sharma A, Ghate S. Pigtail hair in acute telogen effluvium – Lest we forget!. Indian Dermatol Online J [serial online] 2020 [cited 2022 Jan 18];11:444-5. Available from: https://www.idoj.in/text.asp?2020/11/3/444/284120


Telogen effluvium (TE) first described by Kligman in 1961, refers to the loss of club hair (telogen hair).[1] TE can be acute and chronic, further subcategorized into a primary chronic TE (idiopathic) or be secondary. In addition, as it is the most common type of nonscarring hair loss[2] seen in clinical practice, it must be differentiated from androgenetic alopecia (AGA). Although trichoscopic features of TE are not characteristic, upright short regrowing hair have been described most commonly.[3] Rapidly regrowing hair may take the shape of pigtail. There is no published data on presence of pigtail hair in acute TE. Through this short communication, we have described new trichoscopic findings (pigtail hair) in acute TE and response to parenteral corticosteroids. A 27-year-old otherwise healthy woman presented with sudden-onset, severe shedding of hair, for a 3-weeks duration [Figure 1]. She suffered from dengue fever, 3 months ago, for which she was hospitalized. On examination, the scalp was apparently normal, showing no signs of inflammation. There was no sparseness of hair noted. Her hair pull test was highly positive from all over the scalp. The number of shed hair in 60 sec was 133. Trichoscopy was done at 20X magnification in polarized mode with FotoFinder video dermatoscope (MEDICAM 1000S, Fotofinder Systems GmbH, Bad Birnbach, Germany) from the vertex, frontal, and occipital areas revealed scaling, multiple pigtail hair and upright regrowing hair, with hair diameter diversity <10% [Figure 2]a and b]. Her 3 days hair count indicated profuse shedding of 1,000–1,200 hair per day [Figure 3]. Thereafter, trichogram was done, and it revealed that 34% hair was in telogen, thus confirming the diagnosis of acute TE. She was given a single dose of 40 mg Triamcinolone acetonide intramuscularly, with nutritional supplementation. She responded well, with hair shedding decreasing by nearly 30% within a week [Figure 4]. Acute TE, by virtue of excessive hair shedding, is a very distressing condition, wherein patients never become bald unless hair loss is more than 50%. Although no specific trichoscopic criteria of TE have been recognized, Rudnicka et al.[3] have added more scientific knowledge on the trichoscopic features of TE. Trichoscopic findings include empty follicles, short regrowing hair of normal thickness, predominance of follicular units with single hair and perifollicular discoloration (peripilar sign), and a large number of regrowing hair.[4],[5] It can be differentiated from diffuse alopecia areata (AA), as presence of multiple vellus hair with peripilar sign is pathognomonic for diffuse AA, which is absent in TE. We propose that there are two types of regrowing hair: Upright re-growing hair, these have a tapered end with frequently vertical position and pigtail hair. Regrowing pigtail hair are short, regularly twisted oval or circular with tapered ends, lightly pigmented and resemble a pig's tail. Regrowing pigtail hair most probably result from rapid hair regrowth, before full recovery of the hair follicle. They are described in alopecia areata, trichotillomania, and even cicatricial alopecia.[3],[4],[5] Through this article we wish to bring the fact that pigtail hair is a newly grown hair and its occurrence to be included in trichoscopic features in TE.
Figure 1: Diffuse nonscarring loss of hair in a female patient

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Figure 2: Trichscopy from the vertex of the scalp (20× magnification; Polarised, FotoFinder video dermatoscope (MEDICAM 1000S, Fotofinder Systems GmbH, Bad Birnbach, Germany). (a) Multiple upright regrowing hair. (b) Multiple pigtail hair

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Figure 3: Hair bunch of near about 1,000 hairs in a day

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Figure 4: Hair count showing a significant decrease in hair shedding in a week

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Klingman A. Pathologic dynamics of human hair loss. Arch Dermatol 1961;83:175-98.  Back to cited text no. 1
Malkud S. Telogen effluvium: A review. J Clin Diagn Res 2015;9:WE01-3.  Back to cited text no. 2
Rudnicka L, Olszewska M, Rakowska A, Slowinska M. Trichoscopy update. J Dermatol Case Rep 2011;5:82-8.  Back to cited text no. 3
Torres F, Tosti A. Trichoscopy: An update. G Ital Dermatol Venereol 2014;149:83-91.  Back to cited text no. 4
Rudnicka L, Olszewska M, Rakowska A. Atlas of Trichoscopy. New York: Springer 2013.  Back to cited text no. 5


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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