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Understanding Hair Loss Caused By Telogen Effluvium

What Is Telogen Effluvium?

Telogen effluvium is a type of hair loss that typically occurs after a period of intense stress or other shock to the system. The hair loss that occurs with telogen effluvium is usually on the top of the scalp.

The cycle of hair typically has three phases:

  • Anagen phase, when individual hairs are actively growing and lengthening.
  • Catagen or transitional phase, when hair slows and stops but the hair shaft is still attached.
  • Telogen or resting phase, when the hair shaft detaches, and hair shedding takes place to make room for new hair.

With telogen effluvium, an abnormally large amount of the hair is in the telogen phase.

Under normal circumstances and absent unusual stress, 5 to 10 percent of a person’s hair is in the telogen phase at any one time. With telogen effluvium, the anagen phase slows down, meaning that fewer hairs enter the next two stages. As a result, about 30 percent of hair follicles move into the telogen phase, and above average hair loss occurs.

What Causes Telogen Effluvium?

Telogen effluvium is directly related to stress, trauma, or another shock to the system. Unlike many types of hair loss, telogen effluvium is not permanent, and the hair shedding typically occurs about 3 months after a stressful event. 

There are various other causes, including a poor diet. A shortage of dietary protein, iron, B-vitamins, and zinc may affect the quality of hair and its patterns.

Sudden weight loss, whether intentional or unintentional, may cause hair to shed due to the stress placed on the body by a large change in weight.

Pregnancy triggers a prolonged phase, or anagen phase. This reverses at 3 to 6 months post-partum, causing the common phenomenon of post-pregnancy hair loss, or post-partum telogen effluvium. This is a normal response to all the hormonal changes of pregnancy and post-partum and will eventually result in many very short hairs as those follicles return to the restore phase.

Similarly, menopause and the accompanying hormone changes may also cause telogen effluvium.

Certain prescription and recreational drugs may cause hair loss. If you suspect this, talk to your doctor about the hair loss, and consider alternative treatment options or treatment for the recreational drug use.

Because surgery is usually a shock to the system, post-surgical telogen effluvium may occur. The incidence is affected by the type of procedure, length of stay in hospital, medications, and overall nutritional status.

An interesting side note: change in hair is often mirrored in nail health. In the nails, this may show up as a groove across the nails at the time of the shock to the system, known as a Beau line. The time of the shock can be estimated by knowing that a fingernail takes approximately 5 months to grow from the posterior nail fold to the free edge.

How Does It Compare To Androgenic Alopecia?

Telogen effluvium is not the same as androgenic alopecia.

However, distinguishing between the two can be difficult, especially considering that these conditions are not mutually exclusive. In general, if you are shedding clumps of longer hairs, this is telogen effluvium, where mature hairs are being shed as they enter the telogen phase. If you are shedding small amounts of short hair, this is likely to be androgenic alopecia, where hair is being lost prematurely.

Remember that it is possible to have both conditions occurring at the same point in time. See a dermatologist for a definitive diagnosis.

How Do I Treat Telogen Effluvium?

For simple, uncomplicated telogen effluvium, time and stress management are the best treatment options. Telogen effluvium is usually self-limiting and will reverse on its own in three to six months.

If there are other causes, look at addressing nutritional deficiencies through diet. Non-surgical hair replacement may be another option to consider. For people experiencing menopause-related hair loss, hormone replacement therapy may help.

Stress remains the primary cause of telogen effluvium, so stress management is the primary and most recommended treatment option. Counseling and stress management therapy should be considered as first-line treatment, unless there is a known medical condition or other symptoms of an underlying medical condition.

Avoid chemical or heat treatments that could damage the hair. Use high quality hair care products. Handle your hair gently and avoid over-brushing.

Include protein-rich foods such as meat, eggs, fish, beans, grains, and nuts in your diet. Address possible iron deficiencies by eating lots of dark green leafy vegetables, liver, red meat, beans, and lentils.

If you believe that you are experiencing telogen effluvium, consult with a physician. A physician can perform several tests to diagnose telogen effluvium:

  • The diameter and length of the lost hairs can signal this condition, and may help a doctor to differentiate between this and alopecia.
  • A hair pull test may be carried out to see how much hair is being shed.
  • A wash test can be performed whereby the number of hairs lost during washing is counted.
  • A blood test may be useful to work out the cause of hair loss. These tests can help diagnose iron deficiency or thyroid insufficiency.

A dermatologist might be able to diagnose telogen effluvium and offer advice. They will look at other indicators of hair health, such as the appearance of the scalp, any patches of baldness, or more generalized hair thinning.

If you are diagnosed with telogen effluvium, don't panic.  Remember that it is an extremely common reaction to a stressful event.  It is temporary and usually lasts for around six months.  And, while no specific treatment exists, simple lifestyle and dietary changes can be very effective to reverse it and trigger hair in a short amount of time.