Telogen Effluvium: "Hair Shedding" not "Hair Loss" By Anais Hacobian, B.S., Jacob Anderson, B.S. and David Robles, MD, PhD
What is Telogen Effluvium?
Telogen Effluvium falls under the category of Alopecia, which is defined as, partial or complete hair loss in areas of the body where there usually is normal hair growth. Telogen Effluvium, though under the umbrella of hair loss is characterized more by the non-scarring, non-inflammatory and thinning or shedding of hair, and is typically temporary and reversible. Therefore, it is best to think of this condition as “hair shedding” not true “hair loss.” The condition is often initiated by a trigger, which can be psychological and/or physical stress, shock or a traumatic event. The condition has the potential to affect up to 50% of the scalp hair, and may be acute or chronic in nature.
Acute Telogen Effluvium vs Chronic Telogen Effluvium
Acute Telogen Effluvium usually recovers in 6-12 months.
Chronic Telogen Effluvium can last up to 7 years, and in some individuals experience repeated episodes of hair thinning that last for over 6 months at a time.
Who gets Telogen Effluvium?
Telogen Effluvium, particularly acute Telogen Effluvium can affect both sexes and people of all age groups. Telogen Effluvium tends to sneak up on typically healthy women ranging from the ages of 30-60. Most women do not have pre-existing conditions that lead to the condition and are most commonly a result of constant stress, hormonal changes and diet.
The Normal Hair Cycle
The hair cycle has 3 phases:
1. Anagen or growth phase
2. Catagen or transitional phase
3. Telogen or resting phase
In a healthy scalp about 80% to 90% of hair follicles are in the growth phase (anagen). This leaves about 10%-20% of hair follicles in the resting phase (telogen). Typically hair growth occurs for two to four years, then enters into the resting phase for two to four months. As hair begins to grow soon after resting, the new hairs push out and replace the current resting hairs, allowing for natural hair shedding to occur. Scientific studies suggest a person normally loses up to 100 hairs a day as a result of the normal hair cycle.
Telogen effluvium is caused by a more than usual amount of hair follicles being in the telogen phase. In otherwise healthy individuals, when the body is introduced to a trigger, which can be stress, shock or trauma to the system, the hair growth in the anagen phase begins to slow down, increasing the amount of resting (telogen) follicles to about 30% up to 70%. As a result an individual with Telogen Effluvium can lose over 300 hairs a day.
Signs and Symptoms of Telogen Effluvium
Common signs and symptoms of Telogen Effluvium are an increased amount of hair loss or thinning of the hair. Thinning of the hair may be localized to one area or diffusely on the scalp. You may also notice some affected areas appear worse than other spots. Another sign is when looking at the hairs that have fallen out, they have a white bulb of skin at the tip. If you notice an unusual amount of hair loss when tied in a ponytail or accumulation of hair on your hair brush, shower drain, or pillow lasting a couple months, this CAN be indicative of Telogen Effluvium.
What are the causes of Telogen Effluvium?
1. Childbirth- Postpartum hair loss- While pregnant, transition from anagen phase to telogen phase is slowed down, causing less hair to be lost. However, after child birth, the transition is accelerated, leading to significant hair loss which can last from 3 to 6 months.
2. Surgical operation- Multiple stressors involving the type of surgery, medication, nutrition and recovery process.
Physical trauma- Sudden “shock” or trauma to the body can also affect the hair cycle.
3. Psychological stress- Hair loss typically is noticed about 3-4 months after the onset of the stressful event.
4. Extreme weight loss, poor diet and nutrition deficiency- Hair requires essential nutrients including protein, iron, B-vitamins and zinc to grow. Deficiency to any of these essential nutrients can affect the quantity and quality of hair growth. Sudden changes of diet accounting for weight loss can affect the hair cycle.
5. Certain medications- Introducing new prescribed or recreational drugs may have an inadvertent effect on hair growth.
6. Pre-existing disorders- This can include autoimmune disorder, scalp disease, and endocrine irregularities (ie. hypothyroidism, hyperthyroidism).
7. Discontinuing contraceptive pills, Hormonal changes, menopause- Contraceptive pills regulate fluctuating hormone levels for women. Discontinuing the medication can trigger the hair follicles to go into a prolonged resting phase. Hormones such as estrogen increase the period of time hair is in the growth phase. As hormone levels decrease during menopause the hair growth period is shorter and hair loss is more frequent.
How is Telogen Effluvium diagnosed?
Telogen Effluvium is typically diagnosed by examination of distinct clinical features. The most common examination is the gentle pulling of hairs out of the scalp; in a patient with Telogen Effluvium, this examination will yield an increased number of hairs and the scalp will appear normal, with no evidence of scarring.
Besides a physical exam, there are a few other techniques used to confirm the diagnosis of Telogen Effluvium. A punch biopsy may be performed to rule out other forms of hair loss like Alopecia Areata. A biopsy of the scalp in a patient with Telogen Effluvium will show an increased number of telogen follicles, which would confirm the diagnosis.
Lastly, as previously mentioned, Telogen Effluvium may be caused by a hormonal condition; thus, your doctor may order blood tests. The two lab results most commonly looked for are iron deficiency and hypothyroidism, which can both contribute to Telogen Effluvium.
Is there any treatment for Telogen Effluvium?
There is no specific treatment or prescription for Telogen Effluvium, but here’s the great news, Telogen Effluvium is not permanent. Correcting any organic cause if present (e.g thyroid dysfunction) may resolve symptoms. Maintaining a good well-balanced diet, proper stress management, taking a multivitamin and biotin optimizes your hair growth potential. Good dietary habits to practice are ones rich in protein, vegetables, and fruit.
While dealing with Telogen Effluvium, it is also recommended to care gently for your hair; do not comb, brush, or massage the hair vigorously. Lastly, the psychological effects of hair loss should not be overlooked. If psychological stress is the cause of the symptoms, it should be dealt with by seeing a psychological-healthcare professional.
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