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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case Reports</span><p id="par0005" class="elsevierStylePara elsevierViewall">Case 1&#58; Female patient&#44; 35 years old&#44; healthy&#46; She had hair loss three months after pregnancy&#44; which lasted three months&#44; followed by spontaneous hair regrowth&#46; The picture was taken 15 months after delivery&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Case 2&#58; Female patient&#44; 51 years old who&#44; three months before the appointment&#44; had severe hair loss after losing weight&#46; The picture shows the hair status three months after the hair loss stopped&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Case 3&#58; Female patient&#44; 45 years old&#46; After losing weight on a restrictive diet&#44; she had significant hair loss and was seen in consultation three months after the loss stopped&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Case 4&#58; Female patient&#44; 34 years old&#46; After a serious car accident&#44; she was hospitalized for an extradural hematoma and amputation of her arm&#46; After three months&#44; she had severe hair loss&#46; The picture shows the patient four months after stabilization of her condition&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Case 5&#58; Female patient&#44; 17 years old&#44; diagnosed with neurofibromatosis&#44; hospitalized due to a severe intestinal infection&#46; She had severe hair loss three months after hospital discharge&#44; which resolved spontaneously&#46; The picture was taken at the consultation three months after hair loss stopped&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Figs&#46; 1</a> to <a class="elsevierStyleCrossRef" href="#fig0020">4</a>show these five cases of telogen effluvium&#44; with a significant amount of hair regrowth hairs in the frontal&#44; bitemporal and occipital regions&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a> shows an analysis of the hair ends&#58; the tapered ends correspond to short regrowing hairs&#46; Trichoscopy of the occipital area revealed several short hairs whose ends show these characteristics&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Diagnosing acute telogen effluvium &#40;TE&#41; after its active phase is over can be a challenge in many cases&#44; especially when the pull test is already negative&#46; The question is whether there is actually any hair loss&#44; if there was a recent effluvium or if the patient &#40;usually female&#41; has an increased perception of this situation&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The diagnosis of TE is essentially clinical&#44; as laboratory tests&#44; trichoscopy or histopathological alterations usually do not confirm the diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> A trichogram may be helpful when more than 20&#37; of telogen hairs are present in it&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> The main differential diagnosis includes alopecia areata&#44; as substantial hair loss can be diffuse or occur in localized areas&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> In active diffuse alopecia areata the mild pull test is usually positive for anagens&#44; the trichogram may show dystrophic anagen hairs&#44; trichoscopy shows black and yellow dots&#44; exclamation hairs&#44; and there may be short regrowing hairs&#46; The histopathological analysis may show lymphocytic peribulbitis in the acute phase&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Traction alopecia may also be included in the clinical differential diagnosis&#44; with the fringe sign present on the side undergoing traction&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The trichogram is normal&#44; trichoscopy shows vellus hairs&#44; peripilar cylinders&#44; black dots&#44; and broken hairs&#44; and the histopathological analysis shows preserved sebaceous glands&#44; increased number of telogen and catagen hairs&#44; increased vellus and decreased terminal hairs&#44; in addition to trichomalacia and pigment clumps&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The differential diagnosis can also be made with frontal fibrosing alopecia&#44; ruled out by the presence of numerous vellus hairs in the region of hair implantation&#44; and with female androgenetic alopecia&#44; not confirmed by the absence of hair miniaturization in the presented cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Knowledge of the clinical signs of hair regrowth after telogen effluvium can help in this differential diagnosis&#46; As the frontal and temporal regions of the scalp have a greater number of telogen hairs&#44; these regions seem to be more affected by this process&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Moreover&#44; the hairs on the occipital region&#44; although there is no description of the fact in the literature to date&#44; also seem to show a predominance of telogen hairs&#46; This set of signs&#44; consisting of temporal rarefaction&#44; frontal and occipital fringe&#44; is called the acute telogen effluvium triad after resolution &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figs&#46; 1</a> to <a class="elsevierStyleCrossRef" href="#fig0020">4</a>&#41;&#46; It can help to clinically differentiate which patients are actually undergoing TE or have recently had it&#46; Trichoscopy shows several hairs undergoing regrowth &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The knowledge of this triad can help in the diagnosis of TE and the careful management of patients&#44; with the proposal of a conservative treatment&#44; without the need for more invasive complementary exams&#44; such as a scalp biopsy&#44; for instance&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Financial support</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors&#39; contributions</span><p id="par0075" class="elsevierStylePara elsevierViewall">Leticia Arsie Contin&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the manuscript&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Vanessa Barreto Rocha&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; analysis and interpretation of data&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Five cases of telogen effluvium undergoing resolution are shown&#44; with the presence of frontal&#44; bitemporal&#44; and occipital hair regrowth&#46; Diagnosing acute telogen effluvium after the end of the active phase can be challenging&#44; especially when the pull test is negative&#46; The differential diagnosis includes alopecia areata and traction alopecia&#46; Clinical signs of hair regrowth after telogen effluvium can help in the diagnosis&#46; The frontal and temporal areas have more telogen hairs and are more affected&#46; On the occipital area&#44; hairs seem to have the same behavior&#46; The acute telogen effluvium triad during resolution is proposed&#58; frontal fringe&#44; temporal recess and occipital fringe&#46;</p></span>"
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Images in Dermatology
Acute telogen effluvium triad after resolution
Leticia Arsie Contina, Vanessa Barreto Rochab,
Corresponding author
vanessabarreto.vbr@gmail.com

Corresponding author.
a Dermatology Clinic, Hospital do Servidor Público Municipal, São Paulo, SP, Brazil
b Hospital das Clínicas, Belo Horizonte, Minas Gerais, MG, Brazil
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Female patient&#44; 34 years old&#46; After a serious car accident&#44; she was hospitalized for an extradural hematoma and amputation of her arm&#46; After three months&#44; she had severe hair loss&#46; The picture shows the patient four months after stabilization of her condition&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Case 5&#58; Female patient&#44; 17 years old&#44; diagnosed with neurofibromatosis&#44; hospitalized due to a severe intestinal infection&#46; She had severe hair loss three months after hospital discharge&#44; which resolved spontaneously&#46; The picture was taken at the consultation three months after hair loss stopped&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Figs&#46; 1</a> to <a class="elsevierStyleCrossRef" href="#fig0020">4</a>show these five cases of telogen effluvium&#44; with a significant amount of hair regrowth hairs in the frontal&#44; bitemporal and occipital regions&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a> shows an analysis of the hair ends&#58; the tapered ends correspond to short regrowing hairs&#46; Trichoscopy of the occipital area revealed several short hairs whose ends show these characteristics&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Diagnosing acute telogen effluvium &#40;TE&#41; after its active phase is over can be a challenge in many cases&#44; especially when the pull test is already negative&#46; The question is whether there is actually any hair loss&#44; if there was a recent effluvium or if the patient &#40;usually female&#41; has an increased perception of this situation&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The diagnosis of TE is essentially clinical&#44; as laboratory tests&#44; trichoscopy or histopathological alterations usually do not confirm the diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> A trichogram may be helpful when more than 20&#37; 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trichoscopy shows vellus hairs&#44; peripilar cylinders&#44; black dots&#44; and broken hairs&#44; and the histopathological analysis shows preserved sebaceous glands&#44; increased number of telogen and catagen hairs&#44; increased vellus and decreased terminal hairs&#44; in addition to trichomalacia and pigment clumps&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The differential diagnosis can also be made with frontal fibrosing alopecia&#44; ruled out by the presence of numerous vellus hairs in the region of hair implantation&#44; and with female androgenetic alopecia&#44; not confirmed by the absence of hair miniaturization in the presented cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Knowledge of the clinical signs of hair regrowth after telogen effluvium can help in this differential diagnosis&#46; As the frontal and temporal regions of the scalp have a greater number of telogen hairs&#44; these regions seem to be more affected by this process&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Moreover&#44; the hairs on the occipital region&#44; although there is no description of the fact in the literature to date&#44; also seem to show a predominance of telogen hairs&#46; This set of signs&#44; consisting of temporal rarefaction&#44; frontal and occipital fringe&#44; is called the acute telogen effluvium triad after resolution &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figs&#46; 1</a> to <a class="elsevierStyleCrossRef" href="#fig0020">4</a>&#41;&#46; It can help to clinically differentiate which patients are actually undergoing TE or have recently had it&#46; Trichoscopy shows several hairs undergoing regrowth &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The knowledge of this triad can help in the diagnosis of TE and the careful management of patients&#44; with the proposal of a conservative treatment&#44; without the need for more invasive complementary exams&#44; such as a scalp biopsy&#44; for instance&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Financial support</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors&#39; contributions</span><p id="par0075" class="elsevierStylePara elsevierViewall">Leticia Arsie Contin&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the manuscript&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Vanessa Barreto Rocha&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; analysis and interpretation of data&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Five cases of telogen effluvium undergoing resolution are shown&#44; with the presence of frontal&#44; bitemporal&#44; and occipital hair regrowth&#46; Diagnosing acute telogen effluvium after the end of the active phase can be challenging&#44; especially when the pull test is negative&#46; The differential diagnosis includes alopecia areata and traction alopecia&#46; Clinical signs of hair regrowth after telogen effluvium can help in the diagnosis&#46; The frontal and temporal areas have more telogen hairs and are more affected&#46; On the occipital area&#44; hairs seem to have the same behavior&#46; The acute telogen effluvium triad during resolution is proposed&#58; frontal fringe&#44; temporal recess and occipital fringe&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article&#58; Contin LA&#44; Roha VB&#46; Acute telogen effluvium triad after resolution&#46; An Bras Dermatol&#46; 2021&#59;96&#58;605&#8211;8&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital do Servidor P&#250;blico Municipal de S&#227;o Paulo&#44; S&#227;o Paulo&#44; SP&#44; Brazil&#46;</p>"
      ]
    ]
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case 1&#58; &#40;A&#41;&#44; Frontal fringe&#46; &#40;B&#41;&#44; hair rarefaction on the temporal region and &#40;C&#41;&#44; occipital fringe of hair regrowth after effluvium in the post-partum period&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Case 2&#58; &#40;A&#41;&#44; Frontal fringe&#46; &#40;B&#41;&#44; hair rarefaction on the temporal region and &#40;C&#41;&#44; occipital fringe hair regrowth after effluvium post-weight loss&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Case 3&#58; &#40;A&#41;&#44; Frontal fringe&#46; &#40;B&#41;&#44; Hair rarefaction on the temporal region and &#40;C&#41;&#44; occipital hair regrowth fringe after effluvium post-weight loss&#46;</p>"
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      ]
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        "etiqueta" => "Figure 4"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Case 4&#58; &#40;A&#41;&#44; Frontal fringe&#46; &#40;B&#41;&#44; hair rarefaction on the temporal region and &#40;C&#41;&#44; occipital hair regrowth fringe after a serious car accident&#59; Case 5&#58; &#40;D&#41;&#44; Frontal fringe&#44; &#40;E&#41;&#44; temporal rarefaction and &#40;F&#41;&#44; occipital hair regrowth fringe post-effluvium after severe intestinal infection&#46;</p>"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analysis of hair ends&#58; &#40;A&#41;&#44; the tapered ends correspond to short regrowing hairs&#46; &#40;B&#41;&#44; Trichoscopy of the occipital area shows several short hairs with tapered ends&#46;</p>"
        ]
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    ]
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                      "titulo" => "Clinical and histological challenge in the differential diagnosis of diffuse alopecia&#58; female androgenetic alopecia&#44; telogen effluvium and alopecia areata--part II"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Werner"
                            1 => "F&#46; Mulinari-Brenner"
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                        0 => array:2 [
                          "etal" => false
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                            1 => "I&#46; Astore"
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                            3 => "C&#46; Ignacioaraujo"
                          ]
                        ]
                      ]
                    ]
                  ]
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ISSN: 03650596
Original language: English
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