Vincenzo Nobile
Telogen effluvium (TE) is one of the commonest occurrences in a trichology clinic, with patients claiming excessive hair shedding. TE is so frequent and worrying as to convey urgently the patient to the dermatologist and to extend the complaint even to social blogs on the web worldwide. In its acute (aTE) form, telogen effluvium clinical course duration does not exceed 6 months. The excessive hair shedding typical of aTE is triggered when a large number of hair in the growing phase of the hair cycle (anagen) prematurely and abruptly enter the resting phase (telogen). The duration of the interruption of the anagen hair growth is not noticed by the patient since the mitotically inactive nature of telogen. Hair shedding is noticed by patients only when hair re-enter the anagen phase and a new hair displace the telogen hair from the follicle. The interruption of mitosis, leading to aTE, may occur on account of chemotherapeutic drugs, acute febrile illness, postpartum hormonal changes, hypothyroidism, iron/zinc deficiency, seasonal variation, crash dieting, low protein intake, and malnutrition. aTE can occur in people of any age and ethnicity and is considered to be a quite common condition in either sex. Women are more likely to have lowered quality of life and restricted social contacts as compared to men as a result of hair loss even if the loss of hair becomes a matter of concern in all individuals irrespective of age and sex. Nail plate fragility is a common condition affecting up to 20% of the population, especially women over 50 years of age, characterized by roughness of the surface of the nail plate, tendency of the nail to peel and split, and fragility of the distal nail. According to causative factor, 2 forms of nail fragility can be distinguished: a primary "idiopathic or brittle nail syndrome" form (BNS) and NF secondary to different causes such as inflammatory nail disorders, infections, systemic diseases and general conditions, traumas and alteration of the nail hydration. Nails affected by BNS appear ragged, thin, and dull. The clinical features of BNS include horizontal splits within the nail plate (onychoschizia) and increased longitudinal ridging or splitting (onychorrhexis): the impairment of intercellular adhesive factors of the nail plate is expressed as onychoschizia; while the involvement of the nail matrix is expressed as onychorrhexis. The majority of subjects experiencing BNS indicate that these nail abnormalities are painful, impair daily activities, and may have a negative impact on occupational abilities. In BNS oral supplementation, trace elements and amino acids (especially cysteine) have been reported to be useful to ameliorate the nail plate condition. BNS is also associated with the presence of depressive disorders, indicating a possible impact on the quality of life of those who experience them, similarly to what occurs with hair loss perception.
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