Dengue-associated telogen effluvium: A report of 14 patients

Background Telogen effluvium (TE) is nonscarring alopecia caused by medications, metabolic or hormonal stress or severe systemic infections. An outbreak of dengue affected > 1% of population in Tainan in 2015 and clusters of patients with dengue-associated TE effluvium were presented in our clinic after the outbreak. Objectives We sought to characterize the clinical features of the patients with dengue-associated TE. Methods A retrospective study was conducted to collect patients with dengue-associated TE from November 2015 to March 2016. Dengue was confirmed by serological tests. Dengue-associated TE was diagnosed based on typical history of hair shedding following dengue and exclusion of other hair diseases. Results There were 14 patients with dengue-associated TE: one Caucasian man and 13 Taiwanese women. The mean age was 40.1 years. The mean time from dengue infection to the onset of hair shedding was 2.1 months and the hair shedding persisted for 2.9 months on average. Ten out of 13 female patients were comorbid with female pattern hair loss. Short re-grown hair was observed under the trichoscope in four patients. Conclusions Physicians should be aware of dengue-associated TE especially in dengue endemic areas or after a dengue outbreak. Thorough medical history, examination and laboratory tests should be obtained to yield correct diagnosis or to identify coexistence of two hair diseases.