Highlights
- As telogen effluvium affects hair in the telogen phase of growth, you’re unlikely to lose all your hair.
- Most cases of telogen hair loss are self-limiting and last fewer than six months.
- For both chronic telogen and acute hair loss, treatment is available.
You may worry about losing all your hair when you suffer from telogen effluvium. Hair shedding is noticeable with this condition, and it happens quickly. But there’s good news: The condition only affects hair in a particular phase of growth, and at any one time, only 10 to 15 percent of your hair is in the affected growth stage.
A better understanding of what telogen effluvium is and its potential causes may help you manage your condition.
What Is Telogen Effluvium?
Telogen effluvium is a condition that primarily affects women aged between 30 and 60, but can also affect men. Acute cases last under six months and may resolve on their own. If you suffer from a chronic case, it may last more than six months.
Telogen refers to a specific phase of the hair growth cycle. In this condition, hair falls out in the telogen phase. To have a better understanding of it, it’s helpful to know more about hair growth cycles.
The Hair Growth Cycle
Your hair moves through four growth cycles:
- Anagen. This is the growing phase, and it lasts for three to five years.
- Catagen. This transition phase is where your hair follicles shrink. It lasts for around 10 days.
- Telogen. The resting phase. New hairs begin to form in the follicles. It lasts for about three months.
- Exogen. The shedding phase, when hairs start falling out.
It’s normal to lose anywhere from 50 and 100 hairs per day in the exogen phase. Hair loss can happen when you’re brushing or washing your hair, for example.
With telogen effluvium, hair falls out during the telogen phase. It happens because more hair follicles become dormant than normal, and it can cause the number of hairs you lose each day to more than double.
Telogen Effluvium Causes
There are lots of potential causes of telogen hair loss. They include:
Hormonal Changes
As with male pattern baldness, hormonal changes can cause telogen hair loss. In women, this usually means events such as pregnancy and menopause. In men, fluctuations in testosterone levels can lead to hair loss. For both men and women, both aging and environmental factors can cause changes in testosterone or estrogen levels.
Physical and Emotional Stress
Stress, shock, and traumatic events can all disrupt hair growth. If you’re losing your hair following a traumatic event, it may last for weeks or months. This includes physical trauma, such as accidents.
You may notice your hair loss beginning weeks after the stressful event. Such cases are often acute.
Medications
The list of drugs that may cause telogen effluvium is extensive. However, they may include the following:
- Hormone drugs. Contraceptives, androgens, and hormone replacement therapy (HRT).
- Antidepressants. Antidepressants may cause hair loss, but some have a higher risk than others. For example, bupropion is more likely to cause hair loss than fluoxetine.
- Anticoagulants. Drugs such as heparin and warfarin have more reports of hair loss than direct oral anticoagulants (DOACs) such as rivaroxaban. However, some people do report hair loss as a side effect of DOACs.
- Anticonvulsants. Both carbamazepine and valproic acid may induce hair loss.
- Blood pressure medications. These include beta blockers and ACE inhibitors.
Health Conditions
Numerous health conditions can cause telogen effluvium. Treating them may restore hair growth.
Your body relies on normal thyroid levels for follicles to stay stable. If you have hypothyroidism, they may enter a dormant state during the telogen phase of growth. Treating hypothyroidism may promote hair growth.
Iron deficiency anemia can also make follicles go dormant because follicles rely on normal iron levels to reach full maturity. A small study revealed that serum ferritin is especially low in hair loss patients.
Vitamin D also plays a role in stimulating hair follicles. You may notice your hair falling out if you’re suffering from low vitamin D.
Symptoms of Telogen Effluvium
The first symptom of telogen effluvium is usually hair loss. Some people find their hair is dry, lifeless, and thinner than usual. You may notice that more hair falls out when you wash or brush it.
Unlike with male pattern baldness, hair loss is rapid rather than slow.
You may also experience an itchy and sore scalp. Rarely, you may lose hair from other parts of your body.
Diagnosing and Treating Telogen Effluvium
Telogen Effluvium Diagnosis
There are several ways to diagnose telogen effluvium. They include:
- Pull test. Avoid washing hair for 24 to 48 hours. Pull hair from a few different areas of the scalp where hair loss is present. If more than 10 percent come out, telogen effluvium is likely. This test can also be used for anagen effluvium.
- Trichogram, aka the pluck test. A selection of hairs is taken from the scalp and analyzed under a microscope. A higher proportion of telogen to anagen hairs indicates a positive result.
- Wash test. Avoid washing your hair for five days. After washing it, collect loose hairs for examination. A high number of hairs indicates telogen effluvium is present, and a dermatologist can examine their length to identify other types of hair loss.
- Scalp biopsy. A scalp biopsy analyzes which phase of growth your hair follicles are in. The test is positive if more than 25 percent are in the telogen phase.
- Blood tests. Your doctor can perform blood tests that may indicate that you have the condition. Low iron levels, low thyroid levels, and low vitamin D are good indicators. However, these results may also indicate alopecia areata, so you may need more testing.
Common Telogen Effluvium Treatments
In a lot of cases, this condition is self-limiting. However, if you have chronic telogen effluvium, you may want to try the following:
- Finasteride. Topical finasteride, either on its own or with minoxidil, may improve hair quality after 24 weeks. Products such as Propecia may help.
- Reduce stress. Stress is a key trigger for hair loss, so work on reducing yours. If you’re struggling with high levels of stress, speak to a doctor.
- Medication review. If you think a medication may be causing your hair loss, talk to your doctor about switching to an alternative. Never stop taking a medication suddenly on your own.
- Diet. Ensuring you eat a healthy and balanced diet is essential.
- Hair thickening shampoos. Some shampoos contain ingredients that may help with your condition, such as minoxidil. Others create a cosmetic effect that makes your hair look thicker.
- Addressing health issues. If an underlying health issue is causing your hair loss, addressing it may resolve the problem.
Managing Your Hair Loss
Telogen effluvium is unlikely to result in your losing all your hair. In many cases, it’s a self-limiting condition that doesn’t need treatment. However, finding and correcting any underlying causes is essential.
When you suffer from chronic telogen hair loss, help is available. You can try topical treatments and medications that promote hair growth.
With chronic and acute hair loss, it’s important to see a doctor. They can perform tests that may highlight underlying conditions that require treatment.
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