Telogen Effluvium

Symptoms

Telogen effluvium is a non-scarring, diffuse hair loss that occurs suddenly. More hairs than usual fall out all over the scalp hair. They are easily pulled out and left behind when brushing, showering or on the pillow. “Telogen” refers to the resting phase of the hair cycle, “effluvium” means increased hair loss see also under hair. Full hair signals health, fertility and youthfulness. The loss of hair is traumatic and, depending on its extent, can be a major psychosocial problem. Therefore, it is important to educate those affected about the benign nature of the condition. No baldness develops and the process is reversible.

Causes

In acute telogen effluvium, more hair than usual suddenly falls out 2 to 4 months after a specific trigger. The balance of hairs in the growth phase (anagen) and hairs in the resting phase (telogen) is disturbed because many hair follicles synchronously enter the resting phase, at the end of which hair is lost. Therefore, the hair is easily pulled out. Possible triggers include:

  • Pregnancy (telogen gravidarum, postpartum effluvium): hair loss 2-4 months after delivery is very common and is caused by hormonal changes. It is based on a prolonged anagen phase, which leads to full hair during pregnancy. After birth, the hair growth normalizes.
  • Physiological telogen effluvium of the newborn.
  • Severe emotional stress such as a death, divorce, or life-threatening situation
  • Illnesses with high fever such as malaria or other infectious diseases (postfebrile effluvium).
  • Operations, injuries
  • Large blood loss
  • Fast diets, fasting
  • Heavy metal poisoning
  • Allergic contact dermatitis of the scalp

Numerous drugs are associated with increased hair loss, for example, anticoagulants, antihypertensives, retinoids, the oral contraceptives and other hormonal drugs. In the case of the pill, hair may fall out at the beginning of taking the pill or – analogous to pregnancy – after discontinuation. Hair loss is also observed after the cessation of minoxidil therapy. Cytostatic drugs and radiotherapy cause effluvium and damage the hair follicles in the growth phase. Hair loss therefore begins shortly after the start of therapy. In acute telogen effluvium, hair growth normalizes by itself within 3 to 6 months provided that the trigger is removed. Chronic diffuse telogen hair loss may be caused by iron deficiency. Untreated thyroid disorders such as hypothyroidism or hyperthyroidism, malabsorption, malnutrition, zinc deficiency, syphilis, kidney and liver diseases are other important triggers. The so-called idiopathic chronic telogen effluvium (CTE) mainly affects middle-aged women with thick hair and is possibly triggered by a shortening of the hair growth phase. The exact cause is unclear. A clearing develops at the temples. Hair loss lasts longer than 6 months and is dramatic, with entire tufts detaching from the head.

Diagnosis

The diagnosis should be made in medical treatment preferably at the dermatologist. Numerous other forms and mixed forms must be excluded. For example, constitutional hair loss (androgenetic alopecia) is a gradual process in which the hair recedes over a long period of time in a pattern that differs in men and women. In circular hair loss (alopecia areata), round to oval bald patches appear in the hair.

Non-drug treatment

In acute diffuse hair loss with a known past trigger, no treatment is necessary because the hair follicles remain intact and hair growth normalizes on its own within 3 to 6 months or within a year at most. Nutritional supplements may possibly support the process (Lengg et al., 2007, see below). Underlying diseases or nutrient deficiencies should be treated with medicinal and non-drug measures. If medications are the cause, discontinuation or switching to another agent may be indicated. For therapy of chronic telogen effluvium, we refer the reader to the literature.

Drug treatment

Iron can restore hair loss due to iron deficiency to normal.If there is no success despite increased iron levels, there may be another or a further cause for the hair loss, for example androgenetic alopecia. Thyroid hormones or thyrostatic drugs are used to treat hypothyroidism or hyperthyroidism, respectively. Dietary supplements such as nutrients, vitamins, amino acids and minerals help best when there is actually a deficiency. Because they are well tolerated, it is possible to try therapy. Efficacy is not well documented and use should not be uncritical, as the products are relatively expensive and must also be taken regularly for months. A selection of common remedies: