Telogen Effluvium

It is normal to shed approximately 30-150 hairs from our scalp daily as part of our hair cycle, but this can vary depending on washing and brushing routines. Hair regrows automatically so that the total number of hairs on our head remains constant. Telogen effluvium occurs when there is a marked increase in the number of hair shed each day.

An increased proportion of hair shifts from the growing phase (anagen) to the shedding phase (telogen). Usually, only 10% of the scalp hair is in the telogen phase, but in telogen effluvium, this increases to 30% or more. This condition usually happens suddenly and can occur approximately three months after a trigger.

Increased hair shedding in telogen effluvium occurs due to a disturbance of the normal hair cycle. Common triggers of telogen effluvium include childbirth, severe trauma or illness, a stressful or major life event, marked weight loss and extreme dieting, a severe skin problem affecting the scalp, a new medication, or withdrawal of hormone treatment. No cause is found in around a third of people diagnosed with telogen effluvium. 

Telogen effluvium is not inherited, and it can affect all age groups and both genders equally. 

Most people become aware of losing hair in increased amounts. This problem is most noticeable after washing or brushing with more hair being found in the plughole or on the hairbrush or comb. Some people will notice increased hair on the pillow in the morning or around the house. Usually, there are no symptoms, but occasionally telogen effluvium can be accompanied by tenderness and altered sensations in the scalp, known as trichodynia. 

Hair shedding in telogen effluvium is usually from all over the scalp. Hair thickness decreases in the early stages resulting in the thinness of hair volume.

The diagnosis is usually based on appearance and the history of the hair shedding. The hair may be gently pulled to see if an increased quantity of hair is shed (although this test may be falsely negative if the hair has been washed within 48 hours beforehand), and occasionally hairs are plucked from the scalp so that they can be examined under the microscope. Very rarely, a skin biopsy may be required.

Telogen effluvium usually resolves completely without any treatment over several months. The average duration of telogen is approximately 100 days (3 to 6 months), after which period the hair starts growing again. However, depending on the length of the hair, overall hair volume may take months to return to normal gradually. 

Telogen effluvium can return, especially if the underlying cause is not treated or recurs, and would be called chronic telogen effluvium if lasting more than six months.

There is usually no treatment required for telogen effluvium as the hair will start growing back once the trigger is removed.  A blood test may be suggested to rule out other causes of hair loss, such as over- or underactive thyroid and iron deficiency. 

This issue can happen in severe cases of telogen effluvium, but various options for helping disguise the hair loss can be discussed with your doctor. It is very unusual for hair thinning in patients with telogen effluvium to be severe enough to require the use of a wig.

Other types of hair loss There are many different causes of hair thinning, including female pattern hair loss (androgenetic alopecia) that may also appear similar to telogen effluvium, and sometimes there is an overlap of these conditions. 

• You may find that joining a patient support group (see below) and meeting other people with telogen effluvium may be helpful for you to adjust to your condition.
• If you smoke, consider stopping as heavy metals in cigarette smoke may worsen the hair loss.
• Eating a healthy diet, including food that contains iron, protein, fresh fruit, and vegetables, may be helpful. Consider taking supplements if your diet is restricted.