Telogen Effluvium: Is There a Need for a New Classification?

and male alopecia [1–4] . The prerequisite for delivering appropriate patient care is an understanding of the pathologic dynamics of hair loss and a potential multitude of causal relationships. Once the diagnosis is certain, treatment appropriate for that diagnosis is likely to control the problem. Ultimately, the best way to alleviate the emotional distress related to hair loss is to effectively treat it. Diffuse shedding of hair was originally termed ‘defluvium capillorum’. As early as 1932, Sabouraud restricted the term to a sudden diffuse loss of hair following a severe emotional shock, while others applied it to all forms of alopecia [5] . In the 1950s, chronic diffuse alopecia in women was first differentiated from acute and reversible diffuse alopecia, attributable to a readily identifiable cause, and, in 1960, Sulzberger et al. [6] originally reported on an unexplained apparent increase in incidence of diffuse alopecia in women. However, the results of this questionnaire-based study do not allow discrimination between women with diffuse telogen effluvium or female androgenetic alopecia. Moreover, female androgenetic alopecia with its more diffuse thinning of the crown area and an intact frontal hairline, as opposed to male-pattern androgenetic alopecia with its characteristic bitemporal recession of the hair and balding vertex, was originally described by Ludwig [7] only in 1977. Ultimately, in the 1990s, Rushton et al. [8] and Rushton and Ramsay [9] The problems are solved, not by giving new information, but by arranging what we have known since long. Ludwig Wittgenstein (1889–1951)