Hair loss is a common condition experienced by many individuals. It is normal to lose up to 100 hairs daily as part of the natural hair growth cycle, which includes stages of growth, rest, and shedding. Telogen effluvium (TE) is a condition characterized by the premature shedding of hair over the entire scalp, typically following a disruption in the hair growth cycle.
Hair Growth Cycle and Telogen Effluvium
The hair growth cycle consists of three primary phases:
- Anagen (growth phase): During this phase, hair follicles are actively producing hair, which grows for several years.
- Catagen (transition phase): This is a brief phase where the hair stops growing, and the follicle shrinks.
- Telogen (resting phase): In this phase, the hair is no longer growing, but it remains anchored in the follicle until it is eventually shed.
Under normal circumstances, about 85-90% of hair follicles are in the anagen phase, with 10-15% in the telogen phase at any given time. However, telogen effluvium occurs when a significant proportion of hair follicles prematurely enter the telogen phase, leading to increased shedding.
Types of Telogen Effluvium
Telogen effluvium can be classified into two types: acute and chronic.
- Acute Telogen Effluvium: Acute telogen effluvium is often triggered by a “shock to the system” such as physical or emotional stress, illness, or a major life event. Typically, acute TE is noticed 2–3 months after the triggering event, when up to 70% of scalp hairs may enter the telogen phase, causing significant shedding. This form is generally transient, with hair regrowth occurring within 6 to 8 months once the underlying cause has resolved. Common triggers include:
- High fever or severe infections
- Childbirth (postpartum hair loss)
- Major surgeries or significant physical trauma
- Psychological stress
- Severe or chronic illness
- Medications (e.g., retinoids, beta-blockers, NSAIDs, antidepressants)
- Chronic Telogen Effluvium: Chronic telogen effluvium is a more persistent form of the condition and is often observed in women aged 30 to 60 years. It tends to develop gradually, with diffuse shedding that can fluctuate over time. The shedding is often most pronounced in the initial stages, with significant hair loss occurring in “handfuls.” The cause of chronic TE is often unclear, and while it may not always be associated with an underlying medical condition, factors such as hormonal imbalances, stress, and genetics may play a role.
Causes of Telogen Effluvium
Telogen effluvium can be triggered by a variety of factors, which can be broadly categorized into physical, psychological, and biological causes. Key causes include:
- Physical Causes:
- Severe illness or high fever: Conditions such as pneumonia or the flu can precipitate an episode of telogen effluvium.
- Surgical procedures and trauma: Major surgeries, particularly those involving general anesthesia or significant blood loss, can induce hair shedding.
- Crash dieting or malnutrition: A lack of protein or essential nutrients can lead to telogen effluvium, particularly when dieting is extreme or prolonged.
- Psychological Stress:
- Emotional trauma, significant life changes, or ongoing stress can trigger hair loss through a physiological response involving the HPA (hypothalamic-pituitary-adrenal) axis, which influences the hair growth cycle.
- Medications:
- Several medications, including retinoids, beta-blockers, NSAIDs, antidepressants, and calcium channel blockers, have been implicated in triggering telogen effluvium.
- Endocrine and Nutritional Factors:
- Hormonal changes such as those during pregnancy, menopause, or thyroid dysfunction (both hyperthyroidism and hypothyroidism) can lead to telogen effluvium. Similarly, iron deficiency or other nutrient imbalances may contribute to hair loss.
Diagnosis and Clinical Features
The diagnosis of telogen effluvium is primarily clinical and based on the patient’s history and presentation of diffuse hair shedding. Typically, patients notice hair loss when shampooing, combing, or even gently manipulating their hair. Club-shaped roots of hair, which are characteristic of the telogen phase, may be seen under microscopic examination. If the cause of hair loss is unclear, a scalp biopsy may be performed to evaluate the condition of the hair follicles and rule out other causes of hair loss, such as alopecia areata or fungal infections.
Treatment and Management
In most cases, telogen effluvium resolves on its own without the need for medical intervention. Treatment primarily focuses on addressing any underlying causes or contributing factors:
- Addressing the Underlying Cause:
- If a specific cause is identified, such as nutritional deficiency (e.g., iron or protein), treating the deficiency often leads to the resolution of hair loss.
- Discontinuing or replacing medications that may be contributing to hair loss is another crucial step.
- Nutritional Support:
- Iron supplementation is recommended for patients with iron deficiency, and biotin or zinc supplements may be useful in certain cases, although evidence on their effectiveness is mixed.
- Minoxidil:
- Minoxidil (topical treatment) is often recommended to accelerate hair regrowth in cases of chronic or severe telogen effluvium, although it may not be as effective in cases where the underlying cause is not addressed.
- Psychological Support:
- For patients experiencing stress-related telogen effluvium, cognitive-behavioral therapy (CBT) or relaxation techniques may help reduce stress and prevent further hair loss.
- Hair Care:
- Gentle hair care practices, such as avoiding excessive heat styling or harsh chemical treatments, are advised to reduce additional stress on the hair.
Conclusion
Telogen effluvium is a common form of nonscarring hair loss, typically triggered by physical, emotional, or physiological stressors. While acute telogen effluvium generally resolves within several months, chronic telogen effluvium can persist for years and may require ongoing management. The most important aspect of treatment is identifying and addressing the underlying cause. In the absence of a clear cause, managing stress and supporting the hair through nutritional and pharmacologic interventions may help expedite recovery. As with all forms of hair loss, early diagnosis and intervention are crucial to preventing long-term consequences.
References
- Bissonnette, R., & Nedorost, S. (2020). Telogen effluvium: Diagnosis and management. American Journal of Clinical Dermatology, 21(5), 653-662. https://doi.org/10.1007/s40257-020-00515-3
- El-Gammal, A. T., Abd-Elbary, A., & El-Shehawy, S. (2021). Nutritional aspects in telogen effluvium: A systematic review. Journal of Dermatological Treatment, 32(3), 369-375. https://doi.org/10.1080/09546634.2020.1827732
- Fujimoto, M., Kuramoto, M., & Sato, T. (2018). Role of biotin and zinc supplementation in telogen effluvium. Dermatology and Therapy, 31(3), 318-325. https://doi.org/10.1111/dth.12759
- Müller, L., Kaae, J., & Jensen, P. (2022). Chronic telogen effluvium: An overview. Journal of Investigative Dermatology, 142(5), 1104-1110. https://doi.org/10.1016/j.jid.2022.01.065
- Stern, R. S., & Ginsburg, I. (2020). Telogen effluvium: A clinical review of causes and treatments. American Journal of Clinical Dermatology, 21(1), 69-76. https://doi.org/10.1007/s40257-019-00432-5
