Definition

Telogen effluvium is a type of hair loss characterized by thinning or an increase in the amount of hair that falls out. This condition is a common cause of temporary hair loss. Usually, it occurs after stress, shock, or a traumatic event. Telogen effluvium is different from the hair loss disorder called alopecia areata. Telogen effluvium causes temporary hair loss, and hair usually grows back. A person is said to have chronic telogen effluvium if they experience frequent periods of hair loss for more than 6 months.

Causes

The hair cycle generally consists of 3 phases namely:

• Anagen or growth phase
• Catagen or transitional phase
• Telogen or resting phase

Telogen effluvium is associated with the telogen phase. On the scalp of a healthy person, about 85% of hair follicles are actively growing (anagen hair) and about 15% are in the resting phase (telogen hair). Some hairs may also be in the catagen phase. Hair follicles normally grow anagen hair for about 4 years, then rest for about 4 months. New anagen hairs then will start growing underneath the telogen hairs and encourage the telogen hairs to fall out. Therefore, it is normal to lose up to 100 hairs per day on a hairbrush, floor, or pillow due to the normal hair cycle.

If there is a shock to the hair system, as much as 70% of anagen hair may turn into telogen, so the normal ratio of 85%-15% will be reversed. Hair cycle disorders can be caused by several factors, including:

• Severe psychological stress. Prolonged periods of stress can trigger telogen effluvium. Hair loss generally occurs about 3 months after a stressful event
• Poor diet. Hair needs nutrients especially protein, iron, vitamin B, and zinc to grow. If there is a lack of these nutrients, it will affect the quality and quantity of the hair
• Sudden weight loss. Chronic weight loss or caloric deprivation, such as in anorexia nervosa, can lead to hair loss
• Pregnancy and childbirth. During pregnancy, more hair is in the anagen phase for a longer time. The hormonal changes in 3 to 6 months after childbirth can cause hair to fall out. This is called postpartum telogen effluvium. This condition may resolve after a few months or turn into female-pattern alopecia
• Menopause. Hormonal changes that occur during menopause can also cause telogen effluvium
• Medications. Some medications can cause hair loss
• Certain medical conditions, such as autoimmune diseases, conditions affecting the thyroid gland (hyper or hypothyroid), and alopecia areata
• Discontinuation of contraceptive pills
• Surgical operations. The occurrence of telogen effluvium after surgery depends on the surgical procedure, length of hospital stay, medications administered, and overall nutritional status
• Skin diseases affecting the scalp, such as erythroderma
• Acute or chronic illness, especially if accompanied by fever
• Accidents
• Metal poisoning. Contact with toxic chemicals in metals can cause hair loss
• Foreign travel that causes jetlag
• Excessive sun exposure

Risk factor

Acute (sudden) telogen effluvium can occur in all age groups and both sexes. However, chronic (long-term) telogen effluvium without an obvious cause is more common in healthy women aged 30 to 60 years. In this condition, there is an unexplained disruption of the hair cycle.

Symptoms

The main symptom of telogen effluvium is a sudden increase in the amount of hair that falls out, usually a few months after the triggering event. One may notice that more hair is falling out than usual when washing or combing the hair. You may also notice more hair falling out on your pillow. Typically hair loss occurs on the crown of the head. People with telogen effluvium do not lose all their hair, although the hair may become thin.

In most cases, the hair loss is not more than 50%. Telogen effluvium usually lasts for about 6 months, except in cases of chronic telogen effluvium, which may last longer.

Diagnosis

To diagnose telogen effluvium, the doctor will examine the hair that falls out. Several tests can be used to diagnose telogen effluvium namely:

• The shape, diameter, and length of the hair that falls out can point to telogen effluvium and help to differentiate between this condition and alopecia. In telogen effluvium, the hair that falls out has a distinctively shaped root, called club hair. This can be differentiated from anagen effluvium (e.g. in alopecia areata) where the shape of the hair is different
• Hair pull test to see how much hair falls out when pulled
• Hair wash test to count the number of hairs that fall out during hair washing
• Blood tests can be useful in finding the cause of hair loss. It can also help diagnose iron deficiency or thyroid hormone disorders

The doctor will also look for indicators of hair health such as scalp health, the presence of bald patches, or general thinning of the hair.

Management

There is no specific treatment for telogen effluvium, but lifestyle and dietary changes can be effective in initiating hair regrowth. Treatment of telogen effluvium generally depends on the cause of the hair loss. Once the trigger is found and addressed, the hair cycle will usually return to normal and hair will grow back.

Treatment options for telogen effluvium include:

• Correcting nutritional deficiencies through a healthy diet
• Non-surgical hair replacement
• Hormone replacement therapy for people going through menopause
• Counseling to overcome stress or anxiety

In addition, chemical or heat therapies that can damage the hair should be avoided, including hair styling, curling, or perming.

The recommended diet for telogen effluvium is:

• A protein-rich diet. Protein is an important basic ingredient for hair growth. Make sure your diet includes foods rich in protein, such as meat, eggs, fish, nuts, and seeds. The amino acid lysine is especially important for hair growth
• Iron-rich diet. Iron deficiency is associated with telogen effluvium. Changing your diet to an iron-rich diet can help with hair loss. Examples of iron-rich foods are red meat, liver, green leafy vegetables, and beans
• Supplementation may be considered for a short time while awaiting improvement in nutritional status

Complications

In telogen effluvium, hair will generally grow back in 3 to 6 months after the trigger is addressed. Sometimes, the amount of loss decreases but does not stop completely.

However, repeated episodes of acute telogen effluvium can sometimes turn into female pattern hair loss.

Prevention

The only way to prevent telogen effluvium is to prevent the triggering factor, which is to:

• Stress management
• A healthy diet rich in zinc, vitamin D, protein and fatty acids
• Taking care of the hair. Hair follicles are weakest when wet, so it is recommended to comb the hair after it has dried

When to see a doctor?

If you experience hair loss that tends to get worse, then you should consult a doctor. The doctor will help find the cause of the hair loss and find the most appropriate treatment plan for you.

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