What is Telogen Effluvium?
Telogen effluvium is a type of hair loss that can cause widespread, often sudden, hair shedding. This condition can also take on a chronic form that begins more subtly and gradually. Telogen effluvium results in an abundant loss of resting hair, also known as telogen hair, following a stressful physical or hormonal event or because of certain medications. The term “club hair” is sometimes used to describe telogen hair because of its root shape.
In a fully healthy person’s scalp, about 85% of hair is in an active growth phase, called anagen, and 15% is in the telogen or resting phase. There might also be some hairs in a transitioning phase, known as catagen. A hair follicle generally produces active, anagen hair for nearly four years then goes into rest for around four months.
During the resting phase, a new active anagen hair grows underneath and eventually pushes out the telogen hair. If the body continues to be under considerable stress, roughly 70% of the active anagen hair can shift into the resting phase, leading to hair loss.
This type of hair loss is a response to metabolic stress, hormonal changes, or certain medications. It can be triggered by events such as severe illness, major surgery, significant trauma, changes in hormones after giving birth, hypothyroidism, stopping estrogen-based medication, extreme dieting, low protein intake, consumption of heavy metals, and iron deficiency. Several medications can cause telogen effluvium, but it’s most commonly linked to beta-blockers, retinoids (including too much vitamin A), anticoagulants, propylthiouracil, carbamazepine, and some vaccines.
What Causes Telogen Effluvium?
Telogen effluvium is a condition where abnormal amounts of hair fall out due to certain triggers affecting your body. These triggers can include things like having a very high fever, severe infections, major surgeries, extreme physical trauma, major hormonal changes after pregnancy, underactive thyroid, stopping medications that contain estrogen abruptly, drastic dieting, eating too little protein, exposure to heavy metals, and lack of iron.
Several medicines are also known to contribute to telogen effluvium, with the most common ones being beta-blockers (used for conditions like heart disease and high blood pressure), retinoids (including too much vitamin A), blood-thinning medications, a thyroid drug called propylthiouracil, a seizure medication called carbamazepine, and certain vaccines.
Risk Factors and Frequency for Telogen Effluvium
Telogen effluvium is a common condition which causes hair shedding. It’s not limited to a certain age, gender, or race, meaning anyone can get it. Though exact numbers aren’t known, it’s widespread and many people go through at least one episode in their life. It can happen to both men and women, but women are more likely to get it because of hormonal changes after childbirth. Also, women are generally more affected by hair shedding than men and are more likely to seek medical help for it.
patient’s scalp with hair loss resulting from prolonged crash dieting.
Signs and Symptoms of Telogen Effluvium
Acute telogen effluvium is a condition characterized by sudden hair shedding. Unlike some other hair conditions, it typically doesn’t come with other symptoms and it usually lasts less than six months, sometimes significantly less. A significant event that occurred around three months prior to the onset of the shedding (but could be anywhere from one to six months) might be a cause, although patients often don’t make the connection as they might have fully recovered from the event or illness by the time the hair loss occurs.
In terms of physical signs, it’s hard to spot changes unless you compare the patient’s current look with old photos. If the patient comes in during the active shedding phase, a simple pull test might result in at least four hairs coming out. But if they come in after this phase, the test might show normal results. When examining the scalp closely, more short hairs growing closer to the scalp become apparent, but there should be no signs of scarring.
Testing for Telogen Effluvium
Usually, a thorough medical history and physical exam are sufficient to diagnose telogen effluvium, a condition causing temporary hair loss. Sometimes a biopsy may be carried out during acute hair shedding which can attest to a high percentage of telogen hairs. If there’s suspicion of underlying conditions such as hypothyroidism, chronic illnesses, or iron deficiency, further tests may be recommended.
Lab Testing
Hypothyroidism can cause chronic hair loss, so if symptoms such as tiredness, constipation, weight gain and cold sensitivity are noticeable, a thyroid function test may be conducted.
Iron deficiency can be another cause of hair loss. It is tested through a complete blood count, serum iron, iron saturation, and ferritin tests. Your body prioritizes more vital functions like producing blood over maintaining hair, so it’s common to experience hair loss before other iron deficiency symptoms appear. The Ferritin test is an important marker, its low level confirms iron deficiency but its normal level doesn’t always rule out iron deficiency because inflammation can affect its results. Iron saturation test is a more reliable method to detect iron deficiency.
If syphilis is under suspicion due to symptoms such as fatigue, patchy hair loss, sore throat, or swollen lymph nodes, rapid plasma reagin or venereal disease research lab test may be carried out.
Biopsy
Although not often necessary, a scalp biopsy can confirm the diagnosis of telogen effluvium particularly when a gentle hair pull results in the shedding of many telogen hairs. Telogen hair can be identified by the presence of a white bulb and the absence of a gelatinous hair sheath. If a patient is reluctant to undergo a biopsy, serial hair collections can be done where the patient collects all shedding hair over 24 hours and repeats this weekly for three or four weeks. A collection of 100 or more hairs in a day suggests telogen effluvium. The number of hairs collected may decrease if hair loss is improving over the weeks.
Treatment Options for Telogen Effluvium
Acute telogen effluvium is a type of hair loss that typically resolves itself on its own. If the cause behind the hair loss has been found and properly managed, additional treatment may not be necessary. For example, if hormonal imbalances or nutrient deficiencies are causing hair loss, balancing those hormones or supplementing the nutrients can restore hair growth. If a medication is the cause, then stopping that medication could result in hair regrowth.
Although there is no solid evidence to suggest that using topical minoxidil, a medication often used to treat hair loss, can help recover hair in cases of telogen effluvium, it may be beneficial theoretically. Therefore, some patients who want to actively manage their hair loss might choose to use this treatment. Furthermore, recent trials have shown that oral minoxidil can also be an effective alternative, especially for healthy people who have difficulties with topical formulations.
Recent research has also shown that treatments like botulinum toxin A and multivitamin mesotherapy can be beneficial for telogen effluvium, improving hair thickness and the number of follicles (hair growth points on the scalp).
Moreover, it’s important to provide support to individuals suffering from hair loss. Assuring them about the non-threatening nature of the condition and the likelihood of complete hair recovery over time with proper nutrition can be extremely beneficial for their emotional well-being.
What else can Telogen Effluvium be?
When a doctor is trying to figure out if a patient has telogen effluvium (a condition that causes hair loss), they’ll also look at other conditions that may cause similar symptoms. These include:
- Alopecia areata (an autoimmune disease causing hair to fall out in patches)
- Anagen effluvium (hair loss during the growth phase)
- Androgenetic alopecia (commonly known as male or female pattern baldness)
- Scarring alopecia (hair loss due to scarring of the scalp)
- Syphilis (a sexually transmitted infection)
- Trichotillomania (a psychological condition where the person pulls out their own hair)
What to expect with Telogen Effluvium
Telogen effluvium, a type of hair loss, usually only causes minor changes in your looks, and it’s not been known to cause death. It can, however, greatly affect how you feel about yourself, so it’s often recommended to have appointments with a counselor.
While in most cases, people suffering from an acute, or sudden, case of telogen effluvium will likely see their hair growth return to normal. Even with chronic telogen effluvium, which is long-term or persistent hair shedding, there are generally good cosmetic results in the end, as the body continues to produce new hair even as old ones are shed.
Possible Complications When Diagnosed with Telogen Effluvium
Telogen effluvium is a harmless condition that naturally corrects itself. It doesn’t cause any complications. It’s a type of hair loss (alopecia) that doesn’t result in scarring. Even during active hair loss, there won’t be any scarring on your scalp.
Common Features:
- Harmless condition
- Solves itself naturally
- No complications
- Type of hair loss (alopecia)
- No scarring, even during active hair loss
Preventing Telogen Effluvium
It may take up to six months before patients start seeing new hair growth, with it taking even longer before they genuinely notice the growth. During this time, it’s crucial for doctors to reassure patients that such a timeline is typical as the hair goes back into its growth phase, also known as the anagen phase.
Additionally, some patients might be concerned that their regular hair grooming routines might cause more hair to fall out. In such cases, it’s also important to reassure them that it’s perfectly fine to continue their normal haircare routines, including washing and styling, as it won’t worsen the hair shedding situation.