Telogen Effluvium

Along with stretch marks and sleepless nights, hair loss is a common complaint for many pregnant women – but help is at hand at Aurora Dermatology! 
Telogen effluvium

What is Telogen Effluvium?

  • Known as “shock loss”, Telogen Effluvium is a temporary hair loss condition that causes hair loss after some shock to the system. 
  • This hair condition tends to present in otherwise healthy women 30-60 years of age. 
  • It is probably one of the most common hair conditions seen by dermatologists today, and is very common in pregnancy.  
  • Acute Telogen Effluvium, although predominantly a female condition, can also occur in men.

What are the causes of Telogen Effluvium?

  • Hormonal changes are implicated, with the condition usually resolving after delivery, 
  • Acute or chronic illness, especially with fever 
  • Certain endocrine conditions such as thyroid disease either hypothyroidism (underactive thyroid) or hyper thyroidism (overactive thyroid). 
  • Ceasing of the contraceptive pill 
  • Too much sun exposure 
  • Physical stress such as an accident or operation 
  • Psychological stress 

What are the symptoms of Telogen Effluvium?

  • Noticeable hair loss – only up to 100 hairs a day is normal
  • Increased hair on the pillow, in the shower, coming out in clumps in your hand 
  • Dry hairs fall out easily 
  • Can affect up to 50% of the scalp hair, with hair fall noticed 2 to 4 months after the triggering event. 
  • At first, the hair fall is profuse leading to general thinning of the scalp, but this tapers back in most cases. 
  • Quite often the “shock” is reflected in the nail bed too with a “beau’s line” which is a horizontal ridge on the nail. 
  • As it takes a fingernail five months to grow completely, if the groove is halfway, it can be deducted that the “shock event” was 2.5 months ago.  
  • Less commonly hair thinning involves the whole scalp and sometimes loss of other body hair.

How is Tolegen Effluvium diagnosed at Aurora Dermatology?

  • Dr Parisa will perform a special hair test called a pull test, and use a special instrument called a tricoscopy, to examine the hair at the base. 
  • The length and diameter of the hairs may help Dr Parisa differentiate between this temporary condition and other hair conditions. 
  • She will also take a comprehensive clinical history that will include genetic patterns of hair loss, whether hair loss was sudden or gradual, and what has made it worse (for instance have you started any new medications?). 
  • She may perform a trichogram test (where an agent is used to test hair growth). More than 25% of Telogen hair is highly predictive of Telogen Effluvium. 
  • Dr Parisa may also perform blood tests or a scalp biopsy if she believes the condition is something else OTHER than Telogen Effluvium, however a biopsy is rarely needed. 
  • Differential diagnoses can include alopecia areata (an autoimmune condition), anagen effluvium (hair loss caused by drugs or inflammation) or typical female pattern baldness. 

How long will Telogen Effluvium last?

  • “Many women become quite distressed by losing hair in handfuls during the early stages of acutete telogen effluvium, and we see this commonly in pregnancy,” says Dr Parisa Dermatologist at Aurora Dermatology. 

    “However, the good news is that in the overwhelming majority of cases hair grows back after a few months, usually about 6- 9 months. 

    “Less commonly it can last longer and may be chronic. For this reason, it is always better to see a dermatologist or GP as soon as you notice any worrying hair loss. Early and preventative treatment can make a significant difference in how much hair is lost in the long term,” she says.

Telogen Effluvium v androgenic alopecia v alopecia areata v anagen effluvium – what’s the difference? 

“Telogen Effluvium involves a more rapid pace of shedding, typically over a shorter period and generally after a physical or psychological stress,” says Parisa. 

“Androgenic Alopecia or female pattern baldness is typically more subtle, more gradual and unfortunately more permanent. It tends to be a change in the life cycle of the hair because of hormones that act on hair follicles that are genetically predisposed to baldness.” 

She says that Alopecia Areata, although the most common autoimmune condition in the world, is still far less common than either Telogen Effluvium or Androgenic Alopecia. 

And she says Anagen effluvium is another form of reversible hair loss, but much more rapid than Telogen Effluvium and usually associated with cancer treatments or toxins. 

What are the treatments for Telogen Effluvium?

Lifestyle Tips

  • Treating hair more gently (using a wide-toothed comb, avoiding hot rollers, dyes, peroxide curling irons) 
  • Changing hairstyle and part every few weeks to avoid hair tension on one area of the scalp 
  • Vitamin supplements such as B-Vitamins, iron, zinc 
  • Increasing protein consumption 
  • Reducing stress factors (mindfulness or treating underlying anxiety) 
  • Smoking cessation – smoking impairs the hair growth cycle and can cause severe hair fallout. 
  • Using a cooling cap for patients undergoing chemotherapy 
  • Correcting any thyroid function issues or levels of iron, vitamin B12 or folic acid identified through blood tests.

Treatments

  • If telogen effluvium is not attributed to vitamin deficiency or underlying chronic conditions like infection or inflammation, a wait and see approach may be considered.
  • Platelet rich plasma therapy and hair supplements can aid in accelerating recovery.However in certain situations topical or oral treatments may become necessary.
  • This can include Minoxidil, which comes in liquid, foam and shampoo  or tablet forms. 
  • Possible side effects of topical minoxidil include scalp irritation and unwanted hair on face.

“While hair often grows back in telogen effluvium, achieving a 100% recovery is uncommon. Multiple episodes of telogen efluvium can lead to significant hair thinning and may unmask underlying female pattern hair loss. Starting treatment in the early stages of chronic telogen effluvium is vital because delaying treatment may result in significant hair thinning. ” 

~Dr Parisa Arianejad, Dermatologist.

References

DermNet Telogen Effluvium  

International Society of Hair Restoration Surgery 

Telogen Effluvium Healthline