Editorial Comments on Hair Loss After Ileal Pouch-Anal Anastomosis

In the document, Dr. Thompson reported that 38 percent of patients (9 out of 24) experienced hair loss after undergoing ileal pouch-anal anastomosis, a surgical procedure for ulcerative colitis. This condition, known as telogen effluvium, involves an accelerated transition of hair from the growing phase to the resting phase, leading to shedding and eventual regrowth. The cause of hair loss is considered multifactorial, likely related to metabolic changes from severe systemic illness rather than the surgery itself. Three patients had preoperative hair loss due to acute illness, which could obscure a potential nutritional component to the alopecia. In a personal series of about 100 procedures, the author observed a similar complaint in 5 to 8 percent of patients, suggesting that the actual incidence might be higher if not actively investigated. The alopecia is temporary, and reassurance is the recommended treatment, with hair growth expected to return to normal within six months. Dr. Schoetz added that the hair loss is more likely due to the underlying illness rather than the surgery. Dr. Nivatvongs, commenting on the article, noted that in his experience with 840 pouch procedures, hair loss was not recorded, except in four cases due to prednisone, which resolved after discontinuation of the medication. He also mentioned that alopecia is common in patients with active ulcerative colitis and is usually transient, likely due to nutritional deprivation.