Telogen Effluvium

Round 1

Reviewer 1 Report

Manuscript ID: cosmetics-12147 Telogen effluvium.

 The idea to discuss a frequent hair  disorder  like TE in a cosmetology journal  sounds  good.  However, the present paper is full of statements that I cannot accept.

The best example of them is the interpretation of post-partum TE. Were it a physiological phenomenon, as the Authors  seem to mean,  it would occur in all pregnancies and in all the pregnancies of the same woman. This is not the case. Only about 20% of pregnant women experience TE  after delivery and in general  is the first delivery that is affected. Finding that, close to the delivery ,telogen hairs increase in number, as it has been found,  does not mean that this phenomenon is TE.

Another example is the relationship with thyroid diseases that the Authors  refer to as  one of the causes of TE. Rarely in description of the hair disorders during thyroid diseases  is TE mentioned. It is possible and even probable that hypothyroidism is due to an autoimmune thyroid disease that parallels TE. Dr Sinclair’s paper on chronic TE is a good example of it , as  60% of his patients had Hashimoto thyroiditis.

There are also awkward statements, like (page 3 line128) that inner root sheaths can be seen at naked eye, that  the “normal” hair shedding  is in between 50 and 150 per day, when a recent paper found that is about  20.

The association with trichodynia has not been mentioned, as well as the possible and frequent association with androgenetic alopecia, the modified wash test as a useful way to assess the severity of the hairs shedding and a possible and easier new classification of TE. The recent literature is far from being cited, many papers being neglected.

Lastly,  reference n. 40  deals with a cosmetic product  that would be able to increase the hair shaft thickness and the reference n. 41  with another cosmetic  product that seems to shorten kenogen  promoting the re-entry in anagen phase.  I cannot understand how these two products would contrast the TE mechanism which is totally different from androgenetic alopecia  mechanism.

In conclusion, the paper is an outdated review . 

Author Response

Thanks for your comments on this review.  I have reviewed the literature again and cannot agree with some of your comments.  Below I provided my detailed rebuttals and hope you would accept.

The  best example of them is the interpretation of post-partum TE. Were it a  physiological phenomenon, as the Authors seem to mean, it would occur  in all pregnancies and in all the  pregnancies of the same woman.

Post-partum telogen effluvium is a physiological phenomenon and does occur to varying extent in all pregnancies.

It is possible and even probable that hypothyroidism is due to an autoimmune thyroid disease that parallels TE

This is a true-true non sequitur statement

There are also awkward statements, like (page 3 line128) that inner root sheaths can be seen at naked eye,

127 being extracted with ease from both the vertex and margin of the scalp (Figure 1) [13]. Inspection

128 with the naked eye can distinguish anagen from telogen hairs. Telogen hairs have depigmented bulbs

129 and absence of an inner root sheaths, whereas anagen hairs have inner root sheaths [6]

“normal” hair shedding is in between 50 and 150 per day, when a recent paper found that is about 20.

This assertion is not consistent with my findings published in the British Journal of Dermatology

Reviewer 2 Report

No detailed comments on the content of this review.

I suggest that the basic grammar needs correction throughout. (inappropriate capitalization, subjects and verbs need to be in agreement).

Overall, this calls into question the scientific validity of the entire paper.

Author Response

I found a single spelling error where the gap was omitted between acrodermatitis enteropathica.

Reviewer 3 Report

Although no new information is presented, this is a nicely done review of TE

Author Response

Thanks.