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Telogen Effluvium
Related Subjects: |Nikolsky's sign |Koebner phenomenon |Erythema Multiforme |Pyoderma gangrenosum |Erythema Nodosum |Dermatitis Herpetiformis |Lichen Planus |Acanthosis Nigricans |Acne Rosacea |Acne Vulgaris |Alopecia |Vitiligo |Urticaria |Basal Cell Carcinoma |Malignant Melanoma |Squamous Cell Carcinoma |Mycosis Fungoides (Sezary Syndrome) |Xeroderma pigmentosum |Bullous Pemphigoid |Pemphigus Vulgaris |Seborrheic Dermatitis |Pityriasis/Tinea versicolor infections |Pityriasis rosea |Scabies |Dermatomyositis |Toxic Epidermal Necrolysis |Stevens-Johnson Syndrome |Atopic Eczema/Atopic Dermatitis |Psoriasis
In acute Telogen Effluvium (TE), excessive hair shedding typically resolves within 3–6 months, and hair density usually recovers completely. 🕒💇♀️
ℹ️ About
- Telogen effluvium is a form of diffuse, non-scarring hair loss due to an increased proportion of follicles entering the telogen (resting) phase.
- Normally ~10% of scalp hairs are in telogen; after a major stressor, this can rise to ~30%, leading to shedding about 2–3 months later.
Common Stressors
- 💉 Medical/Physiological: febrile illness, surgery, childbirth (post-partum hair loss), thyroid disease, SLE, HIV.
- 💊 Drugs: heparin, coumarins, propranolol, retinoids (vitamin A), chemotherapy.
- ⚡ Lifestyle/Psychological: bereavement, emotional stress, crash diets, nutritional deficiencies.
The hair pull test is often positive in acute TE, with clumps of telogen hairs easily extracted from the scalp. ✨
🩺 Clinical Features
- More common in women aged 30–60 years.
- Increased daily hair shedding (~300 hairs/day vs normal 50–100).
- Diffuse thinning over the scalp, especially crown; bald patches are not typical (distinguishes from alopecia areata).
- Normal scalp appearance; patients may describe clumps of hair in the shower or on the pillow.
🔎 Investigations
- FBC and ferritin – to exclude iron deficiency anaemia.
- TFTs – to rule out thyroid disease.
- Consider vitamin D, zinc, and B12 if risk factors.
- Scalp biopsy only if diagnosis uncertain (e.g., to exclude early androgenetic alopecia).
💊 Management
- 🔑 Reassurance: Acute TE is self-limiting, resolving within 3–6 months.
- Identify and remove any triggers (drug change, nutritional deficiency, thyroid disorder).
- Optimise general health (balanced diet, treat iron deficiency if present).
- Chronic TE (lasting >6 months) may persist with fluctuating severity but remains benign; supportive care and monitoring are key.
References
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