Alopecia in Cronkhite-Canada Syndrome: Is It Truly Telogen Effluvium?

The document discusses a case of Cronkhite-Canada syndrome (CCS), a rare condition characterized by intestinal polyps, diarrhea, dysgeusia, alopecia, onychomadesis, and hyperpigmentation, which may have an autoimmune component. A 55-year-old man with CCS experienced rapid hair loss, which was initially thought to be telogen effluvium—a condition often triggered by physical stress or malabsorption—since hair-pull testing showed telogen roots. However, trichoscopy and histopathology revealed signs of autoimmune activity, such as black dots and mild lymphocytic infiltrate around vellus anagen hair bulbs, which are not typical for telogen effluvium but suggest similarities to alopecia areata. Treatment with systemic prednisolone led to the resolution of diarrhea, shrinking of polyps, and complete hair regrowth within 13 weeks. This case supports the hypothesis that alopecia in CCS may be partly due to autoimmune mechanisms, challenging the assumption that it is solely telogen effluvium. More studies are needed to establish the pathophysiology of alopecia in CCS.