What is the likely cause of easy hair loss without a visible bulb in a 19-year-old African American Female (AAF) who was last seen normal 8 months ago, with options including excessive oil use or poor nutrition?

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Last updated: March 19, 2025 • View editorial policy

Differential Diagnosis for Hair Loss in a 19-year-old Female

  • Single most likely diagnosis: + Telogen Effluvium: This condition is characterized by excessive hair shedding, often after a major body stress, such as severe illness, psychological stress, or major surgery. The fact that the hair falls out easily without a bulb suggests that the hair is in the telogen phase, which is consistent with telogen effluvium. It's a common cause of hair loss in young women and can be triggered by various factors, including hormonal changes, stress, or nutritional deficiencies.
  • Other Likely diagnoses: + Alopecia Areata: An autoimmune condition that leads to patchy hair loss. While it doesn't typically cause diffuse hair shedding without a bulb, it's a common cause of hair loss in young individuals and should be considered. + Poor Nutrition (option b): Nutritional deficiencies, particularly of iron, zinc, biotin, or vitamin D, can lead to hair loss. Given the patient's age and presentation, a nutritional deficiency is plausible, especially if there have been changes in diet or appetite.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed): + Hypothyroidism: Although less common, hypothyroidism can cause hair loss, among other symptoms like fatigue, weight gain, and cold intolerance. It's crucial to rule out this condition due to its potential long-term consequences if left untreated. + Hyperthyroidism: Similar to hypothyroidism, hyperthyroidism can also lead to hair loss, along with symptoms such as weight loss, palpitations, and heat intolerance.
  • Rare diagnoses: + Androgenetic Alopecia: Although more common in males, female pattern hair loss can occur, especially with a family history. It typically presents with a different pattern of hair loss (thinning over the crown) but should be considered in the differential. + Excessive Oil Use (option a): While excessive use of hair products can lead to hair damage and breakage, it's less likely to cause the specific symptom of hair falling out easily without a bulb. However, it could contribute to hair fragility and should be assessed as part of the patient's hair care routine.

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