Hair
Telogen Effluvium
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Telogen Effluvium
See Also
Alopecia
Definition
Non-scarring, non-inflammatory
Alopecia
involving altered hair cycle
Epidemiology
No gender or age predominance
Pathophysiology
Altered growth cycle where
Telogen
phase predominates
After inciting event, a large number of hairs enter
Telogen
phase (and are lost months later)
Timing
Onset sudden, 2-4 months after inciting event
Resolves months after causative factor resolves
Symptoms
Typically no systemic symptoms at time of
Hair Loss
(but history of trigger 2-4 months prior)
Increased
Hair Loss
with brushing or showering
Loss of 100-300 hairs per day
Affects scalp, axillary and pubic hair
Signs
Uniform hair thinning
Hair
pluck test
More than 4-6 hairs pulled
Hair
s in
Telogen
phase approach 50% (normally <15%)
Consider work-up if >70% in
Telogen
phase
Causes
Endocrine disorders
Hypothyroidism
Hyperthyroidism
Nutritional Disorders
Severe
Iron Deficiency Anemia
Crash dieting or significant dietary limitations (
Malnutrition
)
Zinc Deficiency
Stressors
Severe chronic illness (liver disease or renal disease)
Significant acute infection (high fever)
Postpartum effluvium
Major surgery
Serious psychological stressors
Medications
Heparin
and other
Anticoagulant
s
Heavy Metal
s
Etretinate (Tegison) and other
Retinoid
s
Anticonvulsants
Antithyroid Drug
s (e.g.
Methimazole
, PTU)
Hormonal agents
Oral Contraceptive
discontinuation
Alkylating Agent
s
Lithium
Antihypertensives
Beta Blocker
s
ACE Inhibitor
s
Differential diagnosis
Early
Androgenetic Alopecia
Syphilis
(consider if regrowth delayed)
Associated Conditions
Comorbid
Androgenetic Alopecia
is often present
Labs
Optional
Thyroid Stimulating Hormone
(TSH)
Serum Iron
and
Serum Ferritin
Comprehensive panel (chem18 with
Serum Creatinine
and
Liver Function Test
s)
Management
No treatment is needed in most cases (typically resolves spontaneously in 2-6 months)
Treat underlying cause
Eliminate suspected medication causes
Consider labs as above
Consider empiric 2 weeks of supplemental zinc if nuitritional deficiency suspected
Course
Typically self limited
Resolves in 2 to 6 months spontaneously in most cases
References
Phillips (2017) Am Fam Physician 96(6): 371-8 [PubMed]
Sperling (1998) Med Clin North Am 82:1155-69 [PubMed]
Springer (2003) Am Fam Physician 68(1):93-102 [PubMed]
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