- Telogen Effluvium
- Non-scarring, non-inflammatory Alopecia involving altered hair cycle
- Hair Loss typically follows by 2 to 4 months, a physiologic or emotional stressor
- No gender or age predominance
- Most common cause of diffuse Hair Loss
- Altered growth cycle where Telogen phase predominates
- After inciting event, a large number of hairs enter Telogen phase (and are lost 2-4 months later)
- Telogen phase normally lasts 3 to 5 months, following which hairs are shed
- Scalp Hair Loss may approach 200 hairs per day
- Timing
- Onset sudden, 2-4 months after inciting event
- Resolves months after causative factor resolves
- Typically no systemic symptoms at time of Hair Loss (but history of trigger 2-4 months prior)
- Increased Hair Loss (often in clumps) with brushing or showering
- Loss of 100-300 hairs per day
- Affects scalp, axillary and pubic hair
- Uniform hair thinning
-
Hair pluck test
- More than 4-6 hairs pulled
- Hairs in Telogen phase approach 50% (normally <15%)
- Consider work-up if >70% in Telogen phase
- Idiopathic in some cases
- 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 Anticoagulants (e.g. Warfarin)
- Heavy Metals
- Etretinate (Tegison) and other Retinoids
- Anticonvulsants (e.g. Valproate)
- Antithyroid Drugs (e.g. Methimazole, PTU)
- Antidepressants (e.g. Fluoxetine)
- Isoniazid
- Hormonal agents
- Oral Contraceptive initiation or discontinuation
- Alkylating Agents
- Lithium
- Most common medication cause
- Antihypertensives
- Beta Blockers (e.g. Metoprolol, Propranolol)
- ACE Inhibitors
- Early Androgenetic Alopecia
-
Syphilis (consider if regrowth delayed)
- Comorbid Androgenetic Alopecia is often present
- 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
- Consider Minoxidil during regrowth period if comorbid Androgenetic Alopecia is present
- Onset sudden, 2-4 months after inciting event (physiologic or emotional stressor)
- Typically self limited
- Resolves in 2 to 6 months (up to 9 months) spontaneously in most cases
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