What is the diagnosis for a 27-year-old postpartum (postpartum period) woman presenting with telogen effluvium (hair thinning and falling out in clumps) eight weeks after a vaginal delivery, with normal vital signs and physical examination showing patches of hair loss with new hair growth?

From the Guidelines

The patient's presentation is most consistent with postpartum telogen effluvium, a self-limiting condition that typically resolves within 6-12 months without specific treatment. This diagnosis is based on the clinical presentation of diffuse hair shedding occurring approximately 2-3 months after childbirth, which matches this patient's timeline of being 8 weeks postpartum 1. The physical examination findings of patches of hair loss with evidence of new hair growth and absence of scalp inflammation (no erythema or induration) further support this diagnosis.

Key Points to Consider

• The patient's normal vital signs and physical examination results suggest that there are no underlying systemic conditions that need to be addressed immediately.
• The role of micronutrients, such as iron, in telogen effluvium is still being researched, but current evidence does not support routine screening for iron deficiency in patients with telogen effluvium 1.
• Laboratory testing is not necessary at this time given the classic presentation and absence of symptoms suggesting thyroid dysfunction or other systemic conditions.

Recommendations for Patient Care

• The patient should be advised that the hair shedding is temporary and occurs due to the rapid shift of hair follicles from the growing (anagen) phase to the resting (telogen) phase following the hormonal changes of pregnancy.
• Regular hair care, avoiding excessive manipulation of the hair, and patience are recommended as the hair will typically regrow completely without intervention.
• The patient should be reassured that this condition is common and resolves on its own, and that there are no current treatments that can speed up the recovery process.

From the Research

Diagnosis of Telogen Effluvium

The diagnosis for a 27-year-old postpartum woman presenting with telogen effluvium eight weeks after a vaginal delivery can be based on the following criteria:

• The patient is experiencing hair thinning and falling out in clumps, which is a common symptom of telogen effluvium 2, 3, 4, 5.
• The patient is eight weeks postpartum, which is a common triggering event for telogen effluvium 2, 3, 5.
• The patient has normal vital signs and physical examination shows patches of hair loss with new hair growth, which is consistent with telogen effluvium 2, 4.

Laboratory Investigations

To confirm the diagnosis and rule out other underlying conditions, the following laboratory investigations may be necessary:

• Complete blood count and routine urine examination 2.
• Serum ferritin and T3, T4, and TSH levels to check for iron deficiency and thyroid hormone disorders, which are common conditions associated with diffuse hair loss 2, 6.
• Vitamin D, vitamin B12, folate, and zinc levels to check for nutritional deficiencies, which may contribute to hair shedding 6.

Differential Diagnosis

The differential diagnosis for telogen effluvium includes:

• Female pattern hair loss (FPHL) 2.
• Chronic telogen effluvium (CTE) 2.
• Androgenetic alopecia 4.
• Alopecia areata 4.
• Tinea capitis 4.
• Trichotillomania 4.
• Trichorrhexis nodosa 4.
• Anagen effluvium 4.