Telogen effluvium is a temporary form of hair loss that is characterised by the loss of telogen hairs. It is most noticeable on the scalp, however it can affect any area of hair on the human body. The condition can affect people of any age. In fact, telogen effluvium is reasonably common in babies in the first year of life. It affects both men and women, but due to the role of hormonal factors and childbirth, more women tend to be affected than men. This form of alopecia can significantly affect a person’s confidence and self-esteem.
The hair on our scalp consists of two main types. Anagen hairs are the hairs that are actively growing. The hairs that are in a resting state of growth are called telogen hairs. On average, the hair follicle will be in an active phase of growth producing anagen hairs for three years. The follicle then enters a resting period for approximately three months and then the cycle of hair growth begins. The telogen hairs are pushed out of the scalp by the anagen hairs. So for every telogen hair, there is an anagen hair to replace it. Approximately 85% of the hairs on our head are usually in the actively growing state. The remaining 15% of these hairs are in the resting state.
Telogen effluvium is the body’s reaction to various stressors – including medications, hormones and metabolic events. Some of the stressors that can precipitate telogen effluvium include:
- Pregnancy/childbirth
- Cessation of the contraceptive pill
- Medications- some medications which have been implicated as a cause of telogen effluvium include:
- Beta-blockers, ACE inhibitors- used in the treatment of high blood pressure
- L-dopa- a medication used in the treatment of Parkinson’s disease
- Cimetidine- an inhibitor of H2 receptors used in the treatment of gastro-oesophageal reflux and peptic ulcers
- Lithium- which is used in the treatment of bipolar disorder
- Viral illnesses, particularly if febrile
- Major surgeries or accidents
- Jetlag
- Thyroid disease
- Nervous shock/ stress
- Significant weight or dietary changes
These stressors can cause a large proportion of anagen hairs to enter the telogen phase at the same time. Up to three-quarters of the actively growing anagen hairs can turn into resting hairs. A . The shedding of the hair tends to be noticed 3-4 months after the triggering stressor; this is due to the length of time the hair is in the telogen phase. This is because the shedding of a telogen hair occurs when an anagen hair begins to grow and forces the old anagen hair out of the follicle.
Signs & Symptoms
The first thing that most people notice is an increase in the amount of hair that is being shed. It is normal to lose around 100 hairs from the head each day. Sufferers tend to notice an increase in the amount of hair falling out when brushing their hair and in the shower. There may also be a feeling that the remaining hair is thinner than usual. The temporal region of the hair tends to be most markedly affected.
Changes in the nails may also be noticed, this is because growth of nails and hair are controlled by the same factors. The main change seen in the nail is a horizontal groove/line which signifies a period in which growth of the nail has been arrested. This is known as a Beau’s line. In some cases, telogen effluvium and androgenetic alopecia occur together and this can make an accurate diagnosis more difficult to achieve. The phenomenon of having both telogen effluvium and androgenetic alopecia is most commonly observed in younger females.
Prognosis
Telogen effluvium is a temporary form of hair loss and the sufferer does not lose all of their hair. Treatment is generally not necessary as the individual recovers spontaneously, usually within the first 6 months. Telogen effluvium does not produce any scarring and a full recovery is the most likely outcome.
In rare instances, the condition may be chronic. In this case, the telogen effluvium lasts longer than 6 months and tends to be of an insidious onset with no obvious triggering event. Patients with chronic telogen effluvium are more likely to notice their hair becoming thinner over a period of time, rather than a sudden onset of increased hair shedding. Long-term malnutrition is thought to be an underlying contributing factor to chronic telogen effluvium, particularly if one is deficient in protein. Untreated hypothyroidism is also another causative factor for chronic telogen effluvium. Other symptoms of hypothyroidism include weight gain, feeling cold and constipation. Chronic telogen effluvium may be difficult to distinguish from other hair loss disorders and hence investigations such as scalp biopsies may be necessary to help confirm the diagnosis.