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alopecia due to hyperthyroidism is less clearly established (40). Examples of nutritional influences that can cause diffuse alopecia include caloric deprivation (crash diets), protein-calorie malnutrition, and deficiency in zinc, iron, essential fatty acid, and biotin levels (40). Finally, with regard to psychological stress, it is often difficult to determine its role in hair loss because hair loss itself can be very stressful, thus making it nearly impossible to ascertain which is the precipitating event, stress or hair loss (40).
Diffuse alopecia is usually temporary and resolves without scarring. Once the cause is identified and eliminated, the prognosis for hair regrowth is usually good (40). In some cases (e.g., exposure to multiple chemotherapeutic regimens or ionizing radiation), hair regrowth may be incomplete and may be different in terms of color, shape, or texture (39).
In one of the most common causes of diffuse alopecia, chemotherapy, minoxidil topical solution may have utility in reducing the duration of the induced hair loss. In two studies, one controlled (41) and one uncontrolled (42), minoxidil topical solution was not effective in preventing hair loss associated with chemotherapy. In a placebo-controlled clinical trial by Duvic et al. (43) in which 22 women had undergone surgery and adjuvant chemotherapy for breast cancer, 2% minoxidil topical solution did not prevent hair loss, but it did decrease the duration of chemotherapy-induced hair loss relative to the placebo group.
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