Telogen effluvium (TE) is a condition wherein an individual experiences hair loss during the hair cycle’s telogen or resting stage. In other words, there’s above-normal hair fall – losing 100 hairs per day (on an average) is considered normal. With TE, the daily hair fall count goes up to 300 hairs. The hair fall is generally on the scalp, but some could also experience hair loss in other body areas such as the pubic region or eyebrows. Most of telogen effluvium-induced hair loss is apparent after a hair wash or when combing hair.

Image credit: Flickr
Image credit: Flickr

Telogen effluvium could affect any individual, irrespective of age and gender. Fortunately, unlike other scalp and hair problems, TE is temporary and completely reversible, in most cases. Also, any hair that prematurely gets pushed into the telogen state gets replaced by a growing hair. This means chances of complete baldness due to TE are rare. Telogen effluvium doesn’t hurt the scalp or make the hair look unhealthy. There’s no hair loss in patches either, unlike alopecia areata, but generalized hair thinning.

Hair Cycle and TE Impact

Telogen refers to the last stage (three months) of a hair’s life cycle, wherein the hair is in its resting stage. Post telogen, the hair falls out and makes way for new hair. The two preceding stages are anagen (growth stage – 2 to 4 years) and catagen (transition stage – a couple of weeks). When most of the hair is in the telogen stage, the hair in general looks thinner and lifeless.

Hair follicles (tiny pits in the skin) make hair. Not all hairs are in the same growth stage at a particular period. This is why losing 100 hair strands, on an average, is considered normal because the dead hair gets replaced by new hair. With telogen effluvium, more number of hairs are in the resting stage. Moreover, the dead hair doesn’t get replaced by a healthy new hair.

Based on the period of shedding, telogen effluvium could be chronic or acute. With acute TE, the shedding could last till six months. Hair loss could continue beyond six months in case of chronic telogen effluvium.

Telogen Effluvium Forms

Growing hair follicles may temporarily enter resting state due to perceived environmental shocks. As a result, there’ll be increased hair shedding and diffused scalp hair thinning. If the hair fall trigger isn’t active anymore, the hair follicles would immediately replace the lost hair with fresh hair fibers. This TE form typically lasts for not more than six months. The affected person sees normal scalp hair density in a year.

The second variety has a slower and persistent development. All the hair fibers don’t suddenly fall out of their follicles, and the follicles don’t enter the telogen state all of a sudden. Instead, they enter the resting state as normal. But the telogen phase isn’t followed by the anagen state. Instead, the hair remains in the resting state for a longer time period. As a result, the scalp gets overcrowded with telogen hair.

In the third form, the follicles aren’t in resting state but they have a shortened growth period or anagen phase. This leads to thin hair and continuous shedding of the short hair fibers.

Signs

As aforementioned, telogen effluvium-induced hair fall would be higher when combing or shampooing hair. More hair can be noticed on the pillow cover. The scalp hair would also look or feel less dense than normal.

Causes

Telogen effluvium could be caused by multiple factors.

  • Severe infections or chronic illness such as kidney or liver disease, or thyroid gland issues.
  • Hormonal changes relating to pregnancy or childbirth and menopause.
  • Major surgeries.
  • Extreme weight loss, stress, depression.
  • Medications such as beta blockers, retinoids, antidepressants, calcium channel blockers and non-steroidal anti-inflammatory drugs that includes ibuprofen.
  • Nutrient-deficient diets or crash diets – iron deficiency, low protein intake.

Generally, the hair loss is experienced quite a few months post occurrence of the cause because hairs in the telogen state take at least a couple of months to fall off. The shedding decreases a few months after the hair fall cause has been addressed.

Diagnosis & Treatment

The diagnosis of most telogen effluvium cases begin with hair and scalp examination and study of patient medical history. The hair is often so brittle that it falls out when subjected to even the slightest of force or pressure. The shedding hair could have club-shaped white keratin bulbs, typical of telogen hairs. To confirm presence of the problem, a small sample of the scalp skin is taken for microscopic examination – the process referred to as biopsy. This helps determine the condition of the hair-producing tissues and hair follicles.

There aren’t any major treatments for most telogen effluvium cases. Dermatologists typically prescribe minoxidil to stimulate new hair growth, provided the underlying causal factor is treated. An iron or zinc deficiency is rarely the cause and if so, taking necessary supplements helps cure the issue.

The primary goal is to determine presence of the problem’s underlying cause. Blood tests could be needed if the hair fall reasons are not obvious, or to check for health conditions like a thyroid abnormality. If a particular medicine is causing the issue, the medication must be stopped. Causes such as childbirth, illness, etc. don’t need any treatment. Hair thickness returns once such stress-inducing periods are over.