Telogen Effluvium – Symptoms, Causes, Treatment & Prevention

Telogen Effluvium is a type of hair loss characterised by thinning and shedding of hair from the scalp. This type of hair loss was first described by Kligman in 1961 as a disease of hair follicle. Telogen Effluvium appears as a diffuse hair loss mainly after the body has undergone severe stress and is often a temporary hair problem. Although the hair starts falling out, the hair follicles remain intact and can start producing hair again resulting in hair regrowth. It is important to understand that every healthy hair typically goes through three basic phases during hair growth cycle: Anagen (growth phase), Catagen (transitional phase), and Telogen (falling phase). The term Telogen Effluvium suggests loss of hair that is in Telogen or falling phase. This article explains the symptoms, causes, treatment options and tips to prevent of Telogen Effluvium.

What is Telogen Effluvium?

Telogen Effluvium is a non-scarring or diffuse hair loss from the scalp. By non-scarring, it means the hair follicles are not damaged and hence the regrowth of hair is possible. This kind of hair loss usually occurs after body gets stressed due to drastic metabolic changes, hormonal imbalances or mental stress. The hair loss in Telogen effluvium usually starts after 3 months of triggering event and can last about 6 months. However, in some people, the hair loss continues for a longer time and can last upto a year. This is known as Chronic Telogen Effluvium. Telogen Effluvium does not cause bald patches on scalp unlike male and female pattern hair thinning. However, it results in overall thinning of hair and diffuse hair loss.

Symptoms and Signs of Telogen Effluvium

Shedding of hair is the most common sign of Telogen Effluvium. Some more prominent symptoms of Telogen Effluvium are listed below

  • Noticeable hair loss during washing or combing hair
  • Healthy looking scalp
  • A generalised hair thinning
  • Hair loss that is temporary
  • Losing hair that has white bulb and lack of shiny sheath
  • Dry, lusterless hair that are sparse and easily pluckable
  • Hair colour changes from dark to brown or red, brown to blond

Diagnosis of Telogen Effluvium

Diagnosis of Telogen Effluvium is usually performed on the basis of,

  • Medical history of recent stressful event
  • Observation of hair for white bulb

The laboratory testing is not required in most cases when there is clear history of a triggering event. However, some experts may take a sample of hair to determine the Anagen to Telogen ratio of hair growth cycle. This can give accurate diagnosis of Telogen Effluvium. Since chronic Telogen Effluvium mainly occurs due to metabolic or biologic cause, the diagnosis requires medical tests such as thyroid test, blood analysis or enzyme analysis.

Some laboratory test that confirm the diagnosis of Telogen Effluvium include,

Hair pull test: This is a method to confirm the diagnosis of Telogen Effluvium. It is performed by grasping a bunch of hair containing 40 to 60 hair strands with thumb and index finger. Under normal condition only 2 to 3 hair are pulled. However, in case of Telogen Effluvium more than 10% hair are easily pulled out from the scalp.

Hair pluck test: Also known as the trichogram. It includes examination of hair and shows if more than 25% of hair is in Telogen phase.

Wash test: It is used to count the number of hair that is falling out. The patient is instructed to wash hair after 5 days of last shampoo. The lost hair is collected in a sink with its drain covered by gauze. The hair entrapped in the gauze is then counted.

Expected Duration

Telogen Effluvium is a temporary hair loss that is expected to reverse with six months. Since in Telogen Effluvium the hair follicles remain intact, the long Telogen hair is replaced by shorter Anagen hair that starts to grow from the follicle. Once the new Anagen hair starts to grow in 3 to 6 months, the hair loss or alopecia caused by Telogen Effluvium is resolved.

How Does Hair Loss Occur in Telogen Effluvium?

Understanding, the etiology of Telogen Effluvium requires knowledge of the hair growth cycle. A normal healthy hair goes through Anagen or growing phase that lasts for about 2 to 3 years, catagen or transitional phase that lasts for a month, and finally Telogen or falling phase that lasts for about 3 months.

Anagen: During Anagen phase the cell division takes place inside the hair bulb. The older dead cells are pushed out and hair starts growing from hair follicle. At one time almost 80 to 90% of hair stays in this stage.

Catagen: Catagen is the transitional phase that lasts for about one 1 month and is considered as the end of growing phase. The hair follicle starts to reduce in size but the hair remains intact. At one time only about 1% of hair follicles are in catagen phase.

Telogen: Telogen is the falling phase and lasts for about 3 months. It is the final phase of normal hair growth cycle. Once the hair reaches the Telogen phase it starts to fall out from the scalp and the healthy hair follicle then re-enters in the Anagen phase to continue the hair growth cycle.

For healthy hair, the ratio between Anagen to Telogen known as A/T ratio is ideally 80:20. However, some stressful events including pregnancy, metabolic disorders or injury can influence significant number of Anagen hair to stop growing prematurely and subsequently enter catagen phase, followed by Telogen phase. This disrupts the normal A/T ratio and the hair appears thinner due to diffuse hair loss on the scalp.

Prevention of Telogen Effluvium

Telogen Effluvium results from variety of reasons such as pregnancy, ageing, malnutrition, hormonal imbalance, illness, medications, poor circulation, scalp infections and more. Therefore, maintaining a healthy hair is the best way to prevent Telogen Effluvium.

Prevention of Telogen Effluvium can be achieved through

  • Eating healthy and balanced diet
  • Managing stress
  • Getting enough sleep
  • Switching medication that cause hair loss with the help of trichologist
  • Reducing intake of unhealthy food that increase body toxins

Treatment of Telogen Effluvium

Telogen Effluvium in most cases resolves by itself in a span of 6 to 8 months. However, since the main cause of Telogen Effluvium is stress to the body, the treatment begins with identifying the real cause of stress which could be pregnancy, hormonal changes or metabolic disorders. The treatment also includes counselling of patient with respect to the history and understanding of hair cycle.

Treatment plan includes,

  • Reduction in catagen-inducing medication like beta-blockers, anticoagulants, or antithyroid agents
  • Treatment of underlying metabolic or hormonal disorder
  • Supplements with iron, zinc, estradiol, proteins
  • Diet rich in iron
  • Topical application of minoxidil to promote hair growth

Prognosis of Telogen Effluvium

Telogen Effluvium resolves on its own once the Telogen hair falls and Anagen hair slowly starts growing. In about 6 to 8 months hair growth can be seen. With correction of underlying causes, reduction of stress, healthy diet the prognosis of Telogen Effluvium is positive.

Causes of Telogen Effluvium

The hair growth cycle is usually determined by the body’s biological clock. At any given point under healthy condition about 80 to 90% hair are in the Anagen or growing phase whereas about 10% of hair enter falling or Telogen phase. Losing about 100 to 150 hair daily is considered normal. However, metabolic alterations such as pregnancy, malnutrition and other stressful conditions influence the biological clock within hair follicles and it pushes a large number (around 70%) of hair follicles to enter the Telogen phase. This disturbs the normal ratio of Anagen-Telogen causing significant hair loss.

The common causes of Telogen Effluvium include,

  • Emotional stress
  • Serious injuries
  • Major surgery
  • Pregnancy
  • Haemorrhage
  • Crash diet
  • Illnesses such as malaria, tuberculosis, HIV infection
  • Intake oral contraceptives or medications for thyroid disorder, convulsions, high blood pressure
  • Nutritional deficiencies

Who Does Telogen Effluvium Affect?

Telogen Effluvium can affect anyone who has been through an emotional or physical stress. It can affect both the genders. However, since women are more prone to hormonal changes due to pregnancy and menopause, hair loss due to Telogen Effluvium is seen more commonly in women. In addition women with long and thick hair tend to get more distressed due to significant amount of hair loss and present to the clinic. Chronic Telogen Effluvium is also been reported mainly in women.

Telogen Effluvium can commonly affect anyone who has been through,

  • Pregnancy
  • Difficult labour
  • Major illness
  • Sudden excessive diet plan
  • Thyroid disorder
  • Renal failure


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