Telogen Effluvium - Why, When, and How

Article by HairlossTalk.com

How do I know if I have TE?

Making the diagnosis of a telogen effluvium is usually quite straightforward. A ‘hair pull’ will determine whether or not a disproportionate number of hair follicles are in the telogen phase. And this is a test, which the patient can do himself or herself. Pinch a bunch of hair between your thumb and middle finger. You will have approximately 25 to 30 hairs within the pinch. Give the bunch of hair a sharp tug. Repeat this tug in several places over the scalp. It would be normal to dislodge one or two hairs with each pull, because approximately 10% of the hairs on the scalp are in the telogen phase. The hairs that are dislodged should have a small, friable, whitish bulb on the scalp end. If you pull out more than 4 or 5 hairs in each pull, it’s likely that you are having a period of telogen effluvium. For an accurate pull test, it is important that you have washed your hair regularly, i.e. daily or every other day. With infrequent washing, more hair than normal may pull out giving an erroneous interpretation. Since a telogen effluvium is not limited to the hair follicles at risk for MPB or FPB, shedding can involve hair on any part of the scalp (and even body hair). The underlying scalp has a normal appearance without scarring or inflammation and there should not be any areas of complete alopecia. A close examination of the scalp may reveal a higher than expected number of short new hairs growing in.

If there is an obvious history of an inciting event and the time elapsed between the inciting event and the excessive shedding is consistent with the approximate length of a telogen phase, laboratory studies are of little use in making the diagnosis. Although a scalp biopsy can be performed to confirm the diagnosis, it would seldom be necessary if the history is characteristic and a ‘hair pull’ produces numerous telogen hairs. There are no signs or symptoms, which allow you to anticipate the shedding from a telogen effluvium.

Treating Telogen Effluvium
Because acute telogen effluvium is in reality a normal process, which occurred prematurely in a synchronized manner to a large number of hair follicles, and which resolves spontaneously, treatment can be limited to reassurance. The identifiable inciting factor should be avoided or discontinued or treated, whichever is appropriate. Assuming there is no intervening pathological process, all of the hair will be replaced in six to twelve months and the replacement hair should be identical to the hair that was shed.

Telogen Effluvium and Miniaturization

Unfortunately, a telogen effluvium can be the harbinger of the onset of Male Pattern Baldness or the initial event in a period of accelerated MPB. In these cases, which are fairly common, the hair also grows back, but the hair may be significantly finer and smaller, because the hair follicles affected have miniaturized by the MPB process. While 5% topical minoxidil is not proven to promote recovery of hair in telogen effluvium, this medication has a theoretical benefit because minoxidil acts directly on hair follicles and promotes anagen growth. Patients who are eager to play an active role in their treatment may wish to use a 5% minoxidil solution. The use of DHT inhibitors is not recommended for the treatment of telogen effluvium.

In Conclusion

Chronic telogen effluvium is more likely to be caused by a chronic metabolic abnormality and is less likely to resolve rapidly. The underlying cause or disorder should be avoided or discontinued or treated, whichever is appropriate, and the patient should have reassurances that the hair loss will not progress to baldness.

Hair transplantation is not a recommended treatment for telogen effluvium.

References:

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Whiting DA: Chronic telogen effluvium: increased scalp hair shedding in middle-aged women. J Am Acad Dermatol 1996 Dec; 35(6): 899-906
Wise RP, Kiminyo KP, Salive ME: Hair loss after routine immunizations. JAMA 1997 Oct 8; 278(14): 1176-8

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