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SUMMARY

Telogen Effluvium (TE) is a normal hair cycle disorder that occurs due to the early hair
follicles termination of the anagen into the telogen phase so that telogen hair falls out in excess.
Diffuse hair loss ranges from 100-1000 strands every day with decreased hair density.
The prevalence and incidence of TE are unknown for sure because many cases are not
reported. Several studies have reported more incidence in women than men, especially in
productive age women or range of 20-50 years, because women at this age have more attention
to the condition of the hair and feel anxious when hair falls out and looks thinner. Productive age
women also get menstruation and postpartum hormonal changes that can trigger TE
The incidence of TE in Cosmetic Division of Mohammad Hoesin Hospital Palembang in
2014-2017 showed that there were 46 new cases of TE or 52.8% among various cases of hair
loss and all cases occurred in women between 13-50 years.
Based on the duration and fluctuation of trigger factors, TE is divided into acute and
chronic, acute TE occurs with a duration of less than 6 months due to precipitating factors such
as high fever, major surgery, acute bleeding, emotional stress, strict diet, postpartum and
ultraviolet induction. Chronic TE occurs with a duration of more than 6 months due to
fluctuating and prolonged precipitating factors such as systemic disease, drugs, significant
weight loss, and nutritional deficiency like iron deficiency. Trigger factors of TE can also be
idiopathic
Iron is an important micronutrient that plays a role in the growth and development of
several cells in the body's organs, including the hair follicle stem cells. Hair follicles are tissues
that continue to experience active metabolism, so they need nutrients for their synthesis and
development. Iron also a cofactor for rate limiting enzyme ribonucleotide reductase which plays
an important role for DNA synthesis and cell replication, besides that iron also affects the
expression of certain genes in the area of hair follicle bulge.
Iron in the body divided into 3 parts; reserve iron, transport iron, and functional iron. Iron
depletion occurs due to reduced iron reserves, but functional and transport iron are normal; iron-
deficient erythropoesis (IDE) occurs due to reserve and transport iron reduced but functional iron
is normal; iron-deficient anemia (IDA) occurs due reserves, transport and functional iron were
reduced.
Iron deficiency can occur due to interference with iron intake, absorption and excretion.
Iron intake is strongly influenced by food from both animal and vegetable sources. Iron
absorption in the intestine can be disrupted in individuals with celiac disease, while excessive
iron excretion occurs in individuals with heavy bleeding
Initial indicator to determine iron depletion or blood iron reserves in the body by
measuring serum ferritin levels. Serum ferritin examination has a greater predictive value for
knowing iron deficiency than other iron status examinations, such as transferrin saturation.
Serum ferritin is a secretory form and glycosylation protein, the level decreases in depletion of
iron reserves in tissues and increases in the state of infection and inflammation.
There are several studies showing the effect of iron deficiency that is known by
measuring serum ferritin levels and most studies have shown a relationship between iron
deficiency and TE. Based on this, the next researcher wanted to know the relationship of serum
ferritin levels with the severity of TE in Mohamad Hoesin Palembang.
TE severity can be assessed through a trichogram examination. Mild TE if the proportion
of telogen hair was 20-40%, moderate TE if the proportion of telogen hair was 40-60%, and
severe TE proportion of telogen hair was more than 60%
This study was a laboratory analytic observational study with a cross-sectional design.
The study was conducted from June to August 2018 at the Cosmetic Division
Dermatovenereology Department Mohammad Hoesin Hospital Palembang, consisting of 30 TE
patients who met the inclusion criteria.
Patients were assessed for TE severity and blood samples were taken for examination of
serum ferritin levels. The covariables included age, sex, education, occupation, body mass index
and TE duration.
The results of the study proved that there was a significant correlation between serum
ferritin levels and TE severity with p = 0.02. Covariables such as age, sex, education, occupation,
body mass index and TE duration have no relationship with the severity of TE. These results
indicate that serum ferritin levels decrease in severe TE without being influenced by age, sex,
education, occupation, body mass index and TE duration.
ABSTRACT

Correlation Serum Ferritin Level with Severity of Telogen Effluvium

Background: most studies have shown a relationship between iron deficiency and Telogen
Effluvium (TE), as measured by serum ferritin levels. Iron deficiency can affect the
differentiation of hair follicles because iron is a micronutrient as forming proteins that are
important for growth and development of hair follicle stem cells. Iron is a cofactor for rate
limiting enzyme ribonucleotide reductase which plays an important role for DNA synthesis and
cell replication, besides that iron also affects the expression of certain genes in the area of hair
follicle bulge. Measurement of serum ferritin levels can be used as an early indicator to
determine iron depletion. Next Researchers want to assess the relationship of serum ferritin
levels with the severity of TE.
Aim: Determine the relationship between serum ferritin levels and the severity of TE.
Method: A laboratory analytic observational study with cross-sectional design was conducted
from June to August 2018. Thirty patients of TE at the Cosmetic Division Dermatovenereology
Department Mohammad Hoesin Hospital Palembang were included by consecutive sampling.
Results: The number of sample is 30 people. All sample is female with the highest age group
were 26-35 years. The mean serum ferritin levels in mild ET (6 patients, 95.31 ± 27.18),
moderate ET (14 patients, 51.03 ± 25.92), severe ET (10 patients, 38.16 ±31.11). The results
showed that there was a correlation between serum ferritin levels with TE severity (p = 0.002),
with moderate correlation strength (r = -0.550).
Coclusions: The level of serum ferritin are decreased according to increasing the severity of TE.
Keywords: telogen effluvium, serum ferritin, telogen efluvium severity