Telogen Effluvium
Telogen effluvium is an increase in hair shedding that leads to reduced hair density. It is a type of transient alopecia that resolves spontaneously once the underlying cause disappears.
Symptoms and Causes
Telogen effluvium is a temporary, sudden, and diffuse hair loss, meaning it occurs homogeneously across the scalp without forming bald patches. It is a type of hair loss caused by an alteration in the hair growth cycle, in which approximately 300 hairs are shed daily, whereas normal shedding ranges between 50 and 100 hairs.
Depending on its duration, telogen effluvium may be classified into two types:
- Acute telogen effluvium: usually resolves within less than six months. It occurs as a consequence of a stressful event and manifests approximately two to three months after it takes place.
- Chronic telogen effluvium: persists for more than six months and, in some cases, may last for years. It occurs continuously over time or in seasonal flare-ups. It is often associated with hormonal alterations, chronic diseases, or nutritional deficiencies.
In most cases, telogen effluvium is reversible, and hair regrows spontaneously once the underlying cause is resolved.
Symptoms
The most significant symptoms of telogen effluvium are:
- Increased hair shedding, noticeable on the pillow, in the shower, or on the comb.
- Reduced hair density on the scalp.
- Hair becomes finer.
Causes
Healthy individuals have approximately 86% of hair follicles in the growth phase (anagen), 1% in the catagen phase (transitional phase), and 13% in the shedding phase (telogen). Telogen effluvium occurs when the hair follicle sustains damage at the root, causing premature interruption of the anagen phase and an early transition into the telogen phase. In these cases, the proportion shifts to approximately 70% of follicles in growth and 30% in shedding.
Damage to hair follicles is triggered by physical, hormonal, or emotional stressors affecting the body. The most common causes include:
- Seasonal changes: shedding is typically more pronounced in spring and autumn.
- Nutritional deficiencies: lack of iron, zinc, or biotin (vitamin B7).
- Endocrine disorders: imbalance in hormone levels or impaired physiological response:
- Hyperthyroidism: excess thyroid hormones.
- Hypothyroidism: deficiency of thyroid hormones.
- Postpartum period.
- Menopause: due to decreased estrogen and progesterone and a relative increase in androgens.
- Miscarriage.
- Discontinuation of hormonal contraceptives.
- Systemic diseases: conditions affecting the entire body or multiple organs simultaneously:
- Cancer.
- Fever.
- Severe trauma.
- Major surgery.
- Psychological stress.
- Anxiety.
- Depression.
- Inflammatory scalp diseases:
- Seborrheic dermatitis.
- Psoriasis.
- Heavy metal toxicity.
- Certain medications:
- Anticoagulants.
- Antiplatelet agents.
- Antidepressants.
- Oral contraceptives.
- Vaccines.
It is common for the causative factor to be difficult to identify because hair shedding typically begins weeks or months after the triggering event.
Risk Factors
Factors that increase the risk of developing telogen effluvium include:
- Sex: more common in women due to hormonal changes throughout life (menstrual cycle, pregnancy, postpartum, menopause, oral contraceptives).
- Age: more frequent between 30 and 60 years.
- Following restrictive diets leading to nutritional deficiencies.
- Emotional stress.
- Traumatic situations.
- Presence of any of the conditions described above.
Complications
Telogen effluvium usually does not lead to complications, and when they occur, they are temporary, as is the condition itself. The most relevant include:
- Chronicity of the condition, which may persist for years.
- Loss of up to 50% of hair.
- Low self-esteem.
- Social withdrawal.
Prevention
Although telogen effluvium is difficult to prevent, maintaining a healthy lifestyle, reducing stress, and following a balanced diet may lower the risk.
Which specialist treats telogen effluvium?
Telogen effluvium is managed within the specialty of Medical-surgical dermatology and Venereology.
Diagnosis
The diagnosis of telogen effluvium usually involves the following steps:
- Medical history: evaluation of symptoms, onset, lifestyle, and any significant events in the preceding months, as well as past medical history and current treatments.
- Scalp examination: assessment of:
- Skin condition (inflammation, scaling, or hairless areas).
- Hair density.
- Hair response to traction.
- Blood test: provides relevant information regarding overall health and potential hormonal imbalances or nutritional deficiencies.
- Trichoscopy: when there are uncertainties regarding the origin of hair loss or the type of alopecia, magnified images of the scalp are obtained to assess hair follicles and hair structure in detail.
Treatment
Telogen effluvium has no specific treatment, as the primary approach is to address the underlying cause. Once it resolves, hair usually regrows spontaneously.
However, to promote scalp health and prevent further deterioration, the following recommendations are advised:
- Maintain a balanced diet rich in protein, vitamins, and iron.
- Avoid excessive heat application to the hair.
- Avoid aggressive hair treatments such as bleaching or chemical straightening.
- Engage in physical exercise or relaxation techniques to reduce stress.
Nutritional supplements may be prescribed to correct deficiencies, or minoxidil (oral or topical), particularly in chronic cases, to prolong the growth phase and reduce shedding.
To manage persistent telogen effluvium, regenerative mesotherapy treatments may be beneficial, including:
- Platelet-rich plasma (PRP) microinjections: autologous growth factors are used to stimulate hair follicles.
- Microneedling: a minimally invasive collagen induction procedure in which microscopic injuries are created on the scalp to stimulate cellular regeneration and increase blood circulation, thereby reactivating hair follicles.
- Low-level laser therapy (LLLT): a non-invasive treatment that stimulates scalp blood flow and strengthens hair follicles.
