Telogen Effluvium

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Telogen Effluvium is the second most common type of hair loss, second only to Androgenetic Alopecia.  It is the result of some physiological stressor or hormonal change and can also be caused by medications or psychological triggers.  It is a form of nonscarring alopecia, which means the hair follicle stays intact so regrowth is probable.  Also, Telogen Effluvium can affect hair on the entire body, but usually only the hair of the scalp is evidenced.

In order to understand this type of hair loss, it is necessary to understand the anagen and telogen phases of the hair growth cycle.  Anagen is the active growth stage which lasts up to 3 years under normal circumstances while telogen is its resting phase.  The resting phase generally involves between 5% and 15% of hair at any given time.  At the end of the anagen phase the normal process is for hair to be shed, or pushed out by new growth after the telogen, or resting stage.  However, in Telogen Effluvium something triggers more of the hair to go into the telogen stage which results in hair loss throughout the scalp and not in localized patches.  There is ample evidence that suggests that Telogen Effluvium may occur independent of the usual growth cycle which means that it is not triggered by anagen growth as is normally the case.

A few other interesting facts about Telogen Effluvium are that it is not age or gender or race specific, and it can be chronic or acute.  It is not uncommon for infants, within the first few months of their lives to go through Telogen Effluvium.  Parents often comment on a baby’s full head of hair and how it is only going to shed anyway.  This is Telogen Effluvium in all its glory!  Also, it is common in postpartum mothers, perhaps due to the rapid change in the hormonal balance within her body or other key stressors involved in childbirth.  Both men and women experience this condition, but since it is a cosmetic disorder, it appears that more women than men seek medical treatment.  There are no statistics that indicate that any race is more prone to this type of hair loss.  And, it can be brought about suddenly (acute) due to some extreme stressor or can be chronic as would be the case with some ongoing imbalance in the body until such time as that imbalance can be identified and rectified.

Acute Telogen Effluvium

This form of hair loss is evidenced in a sudden onset of hair loss throughout the entire scalp.  Patients often report to their physicians that their hair seems to be falling out, or thinning for no apparent reason.  Sometimes the cause can be identified after a careful medical questioning.  Some physiological or metabolic stressor becomes apparent.  Hair loss is not complete which means that total baldness will not be resultant.  This condition generally lasts up to six months with the average being at right around three months.  Hair is lost throughout the entire scalp and the remaining hair appears limp and ‘lifeless.’

Chronic Telogen Effluvium

Chronic Telogen Effluvium is when the shedding of hair lasts longer than six months.  The problem is that the onset is menacing and can be extremely difficult to ascertain what incited it.  Again, patients present with symptoms of unexplained hair loss and as in the acute form, their hair appears thin, lifeless and limp.

Physical Examination to Diagnose Telogen Effluvium

Unfortunately, it is often difficult for the physician to notice an appreciable difference in hair density unless old photos are used to compare the difference.  There are a few ‘tests’ that can be performed, however, to make an accurate diagnosis.  First of all there is the ‘pull test.’  When a clump of hair is gently tugged, if more than four or five strands pull free from the head this is a pretty good indicator that the condition is present.  Also, if there is no obvious inflammation or dermatitis on the scalp, a diagnosis can be made that it is probably this nonscarring form of alopecia.  And the most concrete test is to forcefully extract at least 20 strands of hair.  If they are greater than twenty-five percent of them are in the telogen stage then an accurate diagnosis can be forthcoming.  It should also be noted that complete patches of baldness are not present, hair loss is diffuse.

The Ultimate Cause of Telogen Effluvium

As alluded to above, any illness or physical stressor can trigger the onset of Telogen Effluvium.  Stressors such as childbirth, severe illness, malignancies, lupus, renal disease, major surgery and even serious trauma can incite the onset of Telogen Effluvium.  Also, certain medications and the discontinuation of medications can be a trigger.  For instance, medications that are most commonly a known cause could be (but not limited to) anticoagulants, retinoids, beta-blockers, immunizations, and medications for hypothyroidism.  Heavy metals such as thallium, selenium and arsenic can also be inciters.  Many times people go overboard on dieting and a crash diet can trigger Telogen Effluvium.  Anorexia is a common trigger as is low intake of protein and iron deficiency over a prolonged period of time.

The Good News

Although it may not seem like it at the moment if you are currently experiencing thinning hair that seems to be falling out by the handfuls, there really is light at the end of the tunnel.  If you are diagnosed with Telogen Effluvium it is usually only for a short period of time up to approximately six months at the high end and maybe only for a period of one month if the inciter isn’t serious.  It is a hair loss condition that can be corrected often by itself and will not result in total chronic baldness.

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