- Temporary hair loss caused by excessive shedding of telogen phase hair after a systemic shock.
- Telogen hair, also known as club hair, is identifiable by its root shape.
Contrast with Anagen Effluvium
- Anagen Effluvium: Involves shedding of hair in the active growth phase due to drugs, toxins, or inflammatory conditions like alopecia areata.
- Anagen Hairs: Have pointed tips, unlike club hairs of telogen effluvium.
Population Affected by Telogen Effluvium
- Acute Telogen Effluvium: Affects people of all ages and genders.
- Chronic Telogen Effluvium: Commonly seen in healthy women between 30 and 60 years.
Causes and Triggers
- Sudden shift of anagen hairs to telogen phase due to systemic shock.
- Common Triggers:
- Childbirth (postpartum hair loss)
- Illnesses with fever
- Surgeries
- Accidents
- Psychological stress
- Drastic weight loss or diet changes
- Medication side effects
- Hormonal imbalances (e.g., thyroid disorders)
- Stopping contraceptive pills
- Significant jetlag
- Scalp conditions (like erythroderma)
- Extensive sun exposure
Clinical Features and Presentation
- Characterized by diffuse, non-scarring hair loss.
- Increased hair shedding noticed 2-4 months after the trigger.
- Initially, hair loss is substantial, leading to noticeable scalp thinning.
- Over 6–9 months, hair shedding reduces and scalp hair density usually returns to normal.
- New hair growth often visible along the forehead hairline.
- Beau Lines: In nails can indicate the timing of the systemic shock.
Chronic Telogen Effluvium Characteristics
- Persistent, excessive hair shedding for extended periods, sometimes years.
- Anagen phase duration is reduced.
- Often noticed in women with longer, thicker hair.
- May unmask underlying genetic tendencies towards balding.
- Etiology less understood, typically normal hormonal studies in patients.
Diagnostic Approach
- Clinical diagnosis based on history and examination.
- Diffuse thinning without specific bald patches; short, normal-thickness hairs present.
- Pull Test: Reveals increased telogen hairs with typical epithelial sacs.
- Trichogram: Confirming over 25% telogen hairs supports the diagnosis.
- Scalp Biopsy: Seldom required, shows normal hair ratios, increased telogen follicles, minimal inflammation/fibrosis.
Differential Diagnosis Considerations
- Female and male pattern hair loss (different pattern of thinning).
- Diffuse alopecia areata (associated autoimmune conditions like vitiligo).
- Anagen effluvium (more severe hair loss).
- Hair shaft abnormalities like loose anagen syndrome.
- Congenital hair growth disorders.
Management Strategies
- Typically self-resolving; gentle hair care is advised.
- Address underlying scalp conditions or hormonal imbalances.
- Ensure a well-balanced diet, rich in protein, fruits, and vegetables.
- Correct any deficiencies in thyroid function, iron, vitamin B12, and folic acid.
- Psychological support for hair loss impact.
Prognosis and Outcome
- Hair regrowth usually occurs post-removal of triggering factors.
- Repeated acute telogen effluvium episodes may progress to female pattern hair loss.
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