Derm Cases · Dermatology / Trichology / Primary Care
OSCE — diffuse hair shedding 3 months after illness: telogen effluvium work-up
An 8-minute OSCE on acute vs chronic telogen effluvium, trigger latency, laboratory work-up, trichoscopy exclusion of scarring/AA, and minoxidil role in CTE.
On this page
Study tools
Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
An 8-minute OSCE on acute vs chronic telogen effluvium, trigger latency, laboratory work-up, trichoscopy exclusion of scarring/AA, and minoxidil role in CTE.
Brief (to candidate)
A 35-year-old woman reports sudden dense shedding of hair clumps 10 weeks after COVID-like illness and iron deficiency. Scalp skin looks normal. You have 8 minutes to diagnose telogen effluvium, exclude red-flag alopecias, investigate triggers, and counsel recovery vs chronic TE management.
[5]Candidate instructions
- Define TE hair-cycle mechanism and typical 2–3 month latency after trigger.
- Distinguish acute TE, chronic TE, and anagen effluvium.
- Perform/interpret pull test and trichoscopy (preserved ostia, no patchy AA signs).
- Order focused labs and list classic drug/illness/postpartum triggers.
- Counsel natural history; consider minoxidil for chronic TE.
Examiner checklist (mark each domain / 10)
| Domain | Key actions expected |
|---|---|
| Mechanism / latency | Synchronous shift into telogen with shedding ~2–3 months after trigger (illness, surgery, crash diet, postpartum, drugs)[1][4] |
| Clinical | Diffuse shedding, positive pull test, normal-looking scalp, preserved density early; patient often brings bags of hair; no scarring[2] |
| Exclude mimics | Patchy AA (exclamation hairs/yellow dots); cicatricial (lost ostia, inflammation); patterned AGA (anisotrichosis); anagen effluvium (chemo days–weeks, dystrophic anagen hairs)[1] |
| Work-up | Ferritin/iron, TSH, CBC, consider vitamin D; drug review (retinoids, anticoagulants, beta-blockers, lithium, valproate, interferons); obstetric/postpartum history |
| Acute vs chronic | Acute TE <6 months usually recovers after trigger removal; chronic TE months–years especially middle-aged women (Whiting description)[5] |
| Management | Reassurance + correct triggers/nutrition; gentle hair care; topical or low-dose oral minoxidil for refractory CTE in specialist practice[8] |
| Communication | Regrowth expected over months if trigger cleared; temporary cosmesis strategies; safety-net if patchy/scarring signs appear |
Model key actions
- Link shedding to a trigger ~2–3 months earlier and confirm non-scarring diffuse pattern.[1]
- Screen iron/thyroid/drugs and treat reversible causes.[2]
- Consider minoxidil only after excluding scarring/AA and for chronic/refractory disease.[8]
Common errors
- Missing scarring alopecia when ostia are lost.
- Calling chemo hair loss “TE” (usually anagen effluvium).
- Unnecessary aggressive systemic immunosuppression.
- Failing to check ferritin/thyroid in reproductive-age women.
References5ShowHide
- [1]Asghar F, et al. Telogen Effluvium: A Review of the Literature. Cureus, 2020.PMID 32607303
- [2]Rebora A Telogen effluvium: a comprehensive review. StatPearls / review, 2019.PMID 31686886
- [4]Headington JT. Telogen effluvium. New concepts and review. Arch Dermatol, 1993.PMID 8447677
- [5]Whiting DA. Chronic telogen effluvium: increased scalp hair shedding in middle-aged women. J Am Acad Dermatol, 1996.PMID 8959948
- [8]Randolph M, Tosti A. Oral minoxidil treatment for hair loss: A review of efficacy and safety. J Am Acad Dermatol, 2021.PMID 32622136