Telogen effluvium (telogen hair loss) is a hair condition in which a large number of hair follicles are affected by an external, non-genetic factor. This causes a disruption of the normal hair cycle. The patient therefore has evenly distributed (diffuse) hair loss on the hairy scalp. The hair loss is usually only temporary, for example as a result of childbirth, but sometimes the symptoms are chronic in nature or a recurrence of hair loss occurs. Medical treatment for hair loss is not necessary because the hair will grow back after a few weeks, months or years. If necessary, the doctor will treat the underlying problem so that the symptoms of the hair condition disappear more quickly.

• Hair growth cycle (hair cycle)

• Anagen phase
• Catagen phase
• Telogen phase

• Epidemiology of telogen effluvium
• Causes: Hair loss due to external source
• Symptoms
• Diagnosis and examinations
• Treatment of diffuse hair loss on the scalp
• Prognosis of hair condition

Hair growth cycle (hair cycle)

The hair cycle is divided into three phases, because not all hair grows at the same time.

Anagen phase

In the anagen phase the hair grows. Approximately 85-90% of the hairs are present in the anagen phase. In women, the growth phase lasts a little longer because they often have longer hair than men. The anagen is characterized by thick, strong and well-colored hairs.

Catagen phase

Approximately 0-6% of the hairs are in the catagen phase. In the catagen phase, the hairs have stopped growing. The hair is still on the scalp, but the hair follicle is gradually shriveling. In this transition phase, the skin thins and the hair color is also less colored.

Telogen phase

Between 2-18% of all hairs are in the telogen phase of the hair growth cycle. In this case, hair loss occurs. At the same time, a new growth cycle starts in the same hair follicle.

Epidemiology of telogen effluvium

Data on the epidemiology of telogen effluvium is limited as of October 2020. Telogen effluvium does not appear to have a predilection for certain racial or ethnic groups. Women are much more likely than men to be affected by the common hair disorder.The use of certain medications may lead to telogen effluvium / Source: Stevepb, Pixabay

Causes: Hair loss due to external source

Telogen effluvium indicates an abnormality in the hair cycle, in which too many hairs end up in the telogen phase (hair loss phase). Telogen effluvium is a form of hair loss that is always the result of an external source. Common causes include:

• temporal arteritis (inflammation of arteries near the temples)
• bleeding
• chronic renal failure
• dermatomyositis (skin rash and muscle problems)
• a chronic skin disease such as allergic contact dermatitis (skin rash with redness and itching), atopic dermatitis (atopic eczema: skin disease with itching), seborrheic eczema (skin disease with dandruff and red skin), psoriasis (chronic skin disease with dry skin and flakes), …
• a high fever period
• a hormonal imbalance:
  • androgenic alopecia (year-old loss and baldness, especially in men)
  • childbirth
  • diabetes mellitus
  • stopping the contraceptive pill
  • hormone therapy
  • hypothyroidism (an underactive thyroid gland)
• an operation (under anesthesia)
• a poor diet such as following a crash diet or malnutrition
• extreme stress
• the use of certain medications such as ACE inhibitors (blood pressure lowering medications), anticoagulants (anticoagulants), antidepressants, antifungals (medications for the treatment of fungal infections), beta blockers (heart rate and blood pressure lowering medications), corticosteroids (powerful anti-inflammatory drugs), NSAIDs ( non-steroidal anti-inflammatory drugs), proton pump inhibitors (drugs that reduce stomach acid), retinoids (including excess vitamin A), statins (cholesterol-lowering drugs), …
• ferriprieve anemia (iron deficiency anemia)
• HIV/AIDS
• cancer in an advanced stage
• liver failure
• metal poisoning: arsenic, gold, mercury lead, selenium and thallium
• syphilis
• systemic lupus erythematosus
• nutritional and vitamin deficiencies such as zinc deficiency, mineral deficiency, essential fatty acid deficiency, biotin deficiency

In approximately one in three patients it is difficult to identify the triggering factor. It is also possible that multiple triggering factors underlie telogen effluvium.

Symptoms

With telogen effluvium, hair from the scalp falls out evenly. This happens acutely (for example due to stress) or chronically (for example due to a chronic illness) and sometimes a recurrence of the symptoms occurs. In the form of alopecia (hair loss), the hair boundaries recede. The patient sometimes experiences pain or tingling in the scalp during hair loss. However, most cases do not involve any pain or other symptoms at all, unless the patient suffers from psoriasis, for example. In the beginning, the hair loss is not yet visible, but when more than twenty percent hair loss has occurred, this is also clearly visible.A blood test is sometimes necessary / Source: Frolicsomepl, Pixabay

Diagnosis and examinations

The doctor listens to the patient’s story and examines the scalp and hair. The doctor then performs a blood test and/or a biopsy of the scalp. If symptoms persist after removal of possible external factors, the patient may be suffering from another form of alopecia (hair loss), as the symptoms in the early stages are sometimes reminiscent of telogen effluvium. For example, androgenic alopecia causes local hair thinning on the top of the head.

Treatment of diffuse hair loss on the scalp

In the acute form of the hair condition, removing the environmental factor is sufficient to resolve the hair loss. The hair then grows back completely. The doctor sometimes prescribes medication for persistent telogen effluvium. For example, minoxidil stimulates hair growth, but the patient must take this medicine regularly. The doctor also treats the underlying problem. For example, if medications are the cause of telogen effluvium, the patient should discontinue this medication for at least three months if possible. Finally, some patients opt to (temporarily) wear a wig.

Prognosis of hair condition

Telogen effluvium is usually a temporary condition that is reversible over time. Most patients recover from the hair condition within a few weeks to months, although it is possible that hair density returns to normal after several months to years. Some patients suffer from long-term complaints (longer than six months). It is also possible that the symptoms return.

read more

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• Itchy scalp: Causes of itching of the head
• Scalp Infections: Causes, Symptoms and Treatment
• Sore scalp: Causes of pain and tenderness