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What

Telogen effluvium is a common condition characterized by hair shedding following an episode of bodily stress. It can affect hair on all parts of the body, but is most noticeable on the scalp. Telogen effluvium is a temporary process that leaves no scarring.

Who

Telogen effluvium is common; however, the exact prevalence has not been documented. It can occur at any age. Girls and boys of all races and ethnicities are affected equally.

Signs and Symptoms

Telogen effluvium causes temporary hair shedding. Scarring, inflammation (reddening of the scalp), complete alopecia (baldness), or bald patches do not occur. Hair shedding may be noticed on a comb, pillow, in the shower, and on the bathroom floor. Hair density may only decrease slightly and usually is unnoticed by others, even doctors. The condition typically resolves in 6 months. In the chronic form of Telogen effluvium, hair shedding lasts longer than 6 months. This form affects women 30-60 years of age. It may be sudden and severe in the early stages, then fluctuate with recovery and relapse. Hair may appear thin and lifeless.

Possible Causes

The hair growth cycle is composed of two phases: anagen, when the hair is growing (lasts about 3 years), and telogen, when the hair is resting (lasts about 3 months). At any given time, approximately 10% of the hair on the scalp is in telogen. When new hair forms in the hair follicle, the telogen hair is pushed out and shed. In Telogen effluvium a large number of hairs (25-50%) enter telogen and are subsequently shed. This occurs in response to a stress to the system and is independent of emerging anagen hair. The stressful event usually occurs 1-6 months prior to the onset of hair loss. Physical triggers of Telogen effluvium include high fever, acute illness, severe infection, trauma, and surgery. Hormonal changes associated with childbirth and menopause, termination of birth control pills, hypo- and hyperthyroidism, extreme weight loss due to crash dieting, anorexia, and low protein intake can cause Telogen effluvium. Iron deficiency in young women due to excessive menstrual blood loss can also be a cause. Telogen effluvium can be a side effect of medications such as beta-blockers, retinoids, vitamin A, propylthiouracil, calcium channel blockers, antidepressants, non-steroidal anti-inflammatory drugs (NSAIDS) such has ibuprofen, anticoagulants, and carbamezapine. Diseases such as lupus, kidney disease, liver disease, and leukemia/lymphoma, as well as exposure to heavy metals like selenium, arsenic, and thallium can also stress the body. Telogen effluvium may also be related to skin disorders such as atopic dermatitis, psoriasis, and seborrheic dermatitis of the scalp. Finally, psychological stress can also trigger this condition.

Diagnosis

Short new hairs may be seen growing in the hairline where shedding has occurred. The pull test, where a doctor will gently tug on the hair, will be positive, yielding at least 4 hairs. Blood tests are typically not performed for acute Telogen effluvium. However, in chronic Telogen effluvium, blood tests to exclude thyroid hormone problems, iron deficiency, lupus, kidney disease, and liver disease may be warranted. If the diagnosis is not clear, a hair collection study can be performed. The patient collects all the hair shed in a 24 hour period once a week for about a month. Normally, less than 100 hairs are shed per day. In Telogen effluvium, up to 300 hairs may be shed daily. In rare situations where the diagnosis is not clear, a scalp biopsy to examine a small piece of the scalp under the microscope can be done. Diagnosis of Telogen effluvium will be confirmed if the biopsy shows that 25-50% of hairs are in telogen phase.

Treatment

Telogen effluvium usually resolves on its own as long as the stressful cause is eliminated. It is important to identify and treat this underlying cause. Medications that could cause Telogen effluvium should be discontinued. Underlying diseases should be treated. A healthy, well-balanced diet with iron supplementation (if deficient) is recommended. Thyroid hormone levels, if abnormal, should be normalized. In most cases no specific treatment for Telogen effluvium is prescribed unless the course becomes chronic. In that case, topical minoxidil (Rogaine) may provide some benefit.

Prognosis

The prognosis for recovery is very good, even for chronic Telogen effluvium. The cosmetic outcome is generally excellent. Baldness does not occur.

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Weblinks

HerAlopecia
Provides information, discussion forums, and a newsletter. American Academy of Dermatology www.aad.org Provides information and research updates.

Google Search for Telogen Effluvium

References and Sources

www.emedicine.com/derm/topic416.htm www.aocd.org/skin/dermatologic_diseases/telogen_effluvium.html www.intelihealth.com/IH/ihtIH/WSIHW000/9339/10836.html