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Talogen Effluvium

Autoimmune cause of patchy hair loss. While highly treatable, patients frequently experience flares throughout life.

Overview

Telogen effluvium, also commonly known as stress induced hair loss, is most of the most common types of acute hair loss in which hair falls in out in clumps. Contrary to androgenic alopecia (male/female pattern hair loss) where hair slowly miniaturizes over time, in telogen effluvium hair falls out rapidly in clumps, often noticed in the shower or when brushing hair. In this article we will discuss the causes, symptoms, diagnosis, treatment, and prognosis of telogen effluvium.

Causes

Hair cycles in three phases. The growth phase is called the anagen phase. This typically lasts anywhere from 3 to 7 years on average. Someone with a long anagen phase will tend to have longer, thicker hair. There is a transition phase called the catagen phase, this takes place over a few days. The final phase of the hair cycle is the telogen phase or shedding phase which takes on average over 2-3 months. When a large number of hairs suddenly exist the anagen growth phase and transition to the telogen shedding phase, we call this telogen effluvium. Telogen effluvium is most often caused by a physical or psychological shock to the system, such as severe illness, surgery, childbirth, trauma, or severe psychological stress. These shocks cause a large number of hairs to enter the telogen (resting) phase all at once, resulting in shedding and hair thinning. It can also be caused by certain medications such as beta-blockers, antidepressants, and anticonvulsants. In 2019-2021, COVID-19 induced telogen effluvium in many number of individuals.

Symptoms

Telogen effluvium typically presents with diffuse hair thinning all over the scalp, rather than patchy hair loss typical of other types of alopecia. The hair loss is usually noticed a few months after the event that caused it, as it takes time for all of the telogen hairs to shed. There are several important mimics of telogen effluvium including alopecia areata which can also cause large amounts of hair to fall out at once. It is important to see a board certified dermatologist to help distinguish the difference. In general, alopecia areata often starts in discrete small patches or patients may have a history of prior hair loss in discrete round patches. Dermoscopy can also help distinguish telogen effluvium from alopecia areata as alopecia areata tends to show yellow globules and exclamation point hairs on dermoscopy.

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Diagnosis

Telogen effluvium is usually diagnosed based on clinical history and physical examination. Dermoscopy or a biopsy is sometimes done to rule out other causes of hair loss such as alopecia areata. Often a past medical and medication history will be performed. Sometimes a laboratory workup including CBC, COMP, TSH/T4, Vitamin D, and Iron Panel will be performed to screen for lab abnormalities that may contribute to telogen effluvium.

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Treatment

Telogen effluvium is a self-limiting condition and usually resolves on its own within several months. Unfortunately given the slow rate of hair growth, even after the hair loss stops it can take 6 to 9 months for hair to regrow to a cosmetically acceptable length. Hair extensions can be used when the hair has started to regrow. If the underlying cause can be identified and treated, such as with medications, this may speed up the resolution of telogen effluvium. In cases where hair loss is severe or persists longer than 9 months, minoxidil either topically with Rogaine 5% or with prescription oral minoxidil may be recommended.

Prognosis/Outlook

Telogen effluvium is a self-limiting condition that usually resolves on its own within 6-9 months. If the underlying cause can be identified and treated, such as with medications or other medical conditions, this may speed up the resolution of telogen effluvium. Telogen effluvium is considered a non scarring form of hair loss meaning the hairs that were lost generally regrow. Sometimes hair may be slightly thinner or less dense than prior to the episode of telogen effluvium.

 
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