Hair

Telogen Effluvium

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Telogen Effluvium

  • See Also
  1. Alopecia
  • Definitions
  1. Telogen Effluvium
    1. Non-scarring, non-inflammatory Alopecia involving altered hair cycle
    2. Hair Loss typically follows by 2 to 4 months, a physiologic or emotional stressor
  • Epidemiology
  1. No gender or age predominance
  2. Most common cause of diffuse Hair Loss
  • Pathophysiology
  1. Altered growth cycle where Telogen phase predominates
    1. After inciting event, a large number of hairs enter Telogen phase (and are lost 2-4 months later)
    2. Telogen phase normally lasts 3 to 5 months, following which hairs are shed
    3. Scalp Hair Loss may approach 200 hairs per day
  2. Timing
    1. Onset sudden, 2-4 months after inciting event
    2. Resolves months after causative factor resolves
  • Symptoms
  1. Typically no systemic symptoms at time of Hair Loss (but history of trigger 2-4 months prior)
  2. Increased Hair Loss (often in clumps) with brushing or showering
  3. Loss of 100-300 hairs per day
  4. Affects scalp, axillary and pubic hair
  • Signs
  1. Uniform hair thinning
  2. Hair pluck test
    1. More than 4-6 hairs pulled
    2. Hairs in Telogen phase approach 50% (normally <15%)
    3. Consider work-up if >70% in Telogen phase
  • Causes
  1. Idiopathic in some cases
  2. Endocrine disorders
    1. Hypothyroidism
    2. Hyperthyroidism
  3. Nutritional Disorders
    1. Severe Iron Deficiency Anemia
    2. Crash dieting or significant dietary limitations (Malnutrition)
    3. Zinc Deficiency
  4. Stressors
    1. Severe chronic illness (liver disease or renal disease)
    2. Significant acute infection (high fever)
    3. Postpartum effluvium
    4. Major surgery
    5. Serious psychological stressors
  5. Medications
    1. Heparin and other Anticoagulants (e.g. Warfarin)
    2. Heavy Metals
    3. Etretinate (Tegison) and other Retinoids
    4. Anticonvulsants (e.g. Valproate)
    5. Antithyroid Drugs (e.g. Methimazole, PTU)
    6. Antidepressants (e.g. Fluoxetine)
    7. Isoniazid
    8. Hormonal agents
    9. Oral Contraceptive initiation or discontinuation
    10. Alkylating Agents
    11. Lithium
      1. Most common medication cause
    12. Antihypertensives
      1. Beta Blockers (e.g. Metoprolol, Propranolol)
      2. ACE Inhibitors
  • Differential diagnosis
  1. Early Androgenetic Alopecia
  2. Syphilis (consider if regrowth delayed)
  • Associated Conditions
  1. Comorbid Androgenetic Alopecia is often present
  • Labs
  • Optional
  1. Thyroid Stimulating Hormone (TSH)
  2. Complete Blood Count
  3. Serum Iron and Serum Ferritin
  4. Comprehensive panel (chem18 with Serum Creatinine and Liver Function Tests)
  5. Consider Vitamin D Levels
  • Management
  1. No treatment is needed in most cases (typically resolves spontaneously in 2-6 months)
  2. Treat underlying cause
  3. Eliminate suspected medication causes
  4. Consider labs as above
  5. Consider empiric 2 weeks of supplemental zinc if nuitritional deficiency suspected
  6. Consider Minoxidil during regrowth period if comorbid Androgenetic Alopecia is present
  • Course
  1. Onset sudden, 2-4 months after inciting event (physiologic or emotional stressor)
  2. Typically self limited
    1. Resolves in 2 to 6 months (up to 9 months) spontaneously in most cases
  • References
  1. Dakkak (2024) Am Fam Physician 110(3): 243-50 [PubMed]
  2. Phillips (2017) Am Fam Physician 96(6): 371-8 [PubMed]
  3. Sperling (1998) Med Clin North Am 82:1155-69 [PubMed]
  4. Springer (2003) Am Fam Physician 68(1):93-102 [PubMed]