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Telogen Effluvium

  • Author: Elizabeth CW Hughes, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: May 03, 2016
 

Background

Telogen effluvium is a form of nonscarring alopecia characterized by diffuse hair shedding, often with an acute onset. A chronic form with a more insidious onset and a longer duration also exists.[1, 2] Telogen effluvium is a reactive process caused by a metabolic or hormonal stress or by medications. Generally, recovery is spontaneous and occurs within 6 months, unless a background of pattern alopecia is present.[3]

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Pathophysiology

Telogen effluvium can affect hair on all parts of the body, but, generally, only loss of scalp hair is symptomatic.

Understanding the pathophysiology of telogen effluvium requires knowledge of the hair growth cycle. All hair has a growth phase, termed anagen, and a resting phase, telogen. On the scalp, anagen lasts approximately 3 years, while telogen lasts roughly 3 months, although there can be wide variation in these times between individuals. During telogen, the resting hair remains in the follicle until it is pushed out by growth of a new anagen hair.

In most people, 5-15% of the hair on the scalp is in telogen at any given time. Telogen effluvium is triggered when a physiologic stress or hormonal change causes a large number of hairs to enter telogen at one time. Shedding does not occur until the new anagen hairs begin to grow. The emerging hairs help to force the resting hairs out of the follicle. Evidence suggests that the mechanism of shedding of a telogen hair is an active process that may occur independent of the emerging anagen hair. The interval between the inciting event in telogen effluvium and the onset of shedding corresponds to the length of the telogen phase, between 1 and 6 months (average 3 mo).

Headington has described 5 functional subtypes of telogen effluvium, based on which portion of the hair cycle is abnormally shortened or lengthened.[4] These subtypes represent variations on the principles discussed above. It is rarely possible to distinguish these subtypes clinically.

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Epidemiology

Frequency

This condition is quite common, but exact prevalence is not recorded. A large percentage of adults have experienced an episode of telogen effluvium at some point in their lives.

Race

No racial predilection is recognized.

Sex

Acute telogen effluvium can occur in either sex if the proper inciting conditions occur. Because hormonal changes in the postpartum period are a common cause of telogen effluvium, women may have a greater tendency to experience this condition. In addition, women tend to find the hair shedding more troublesome than men do; thus, more women seek medical attention for the condition. Chronic telogen effluvium has been reported mainly in women.

Age

Telogen effluvium can occur at any age. It is not uncommon for infants in the first months of life to experience an episode of telogen effluvium.

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Prognosis

Mortality has not been reported. Morbidity is limited to mild cosmetic changes. However, telogen effluvium can have substantial impact on those affected.[5, 6]  Prognosis is good for recovery of normal hair density in acute telogen effluvium. A good cosmetic outcome can be expected in chronic telogen effluvium, even if hair shedding continues.

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Contributor Information and Disclosures
Author

Elizabeth CW Hughes, MD Dermatologist, Group Health Cooperative

Elizabeth CW Hughes, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Leonard Sperling, MD Chair, Professor, Department of Dermatology, Uniformed Services University of the Health Sciences

Leonard Sperling, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References
  1. Sinclair R. Chronic telogen effluvium: a study of 5 patients over 7 years. J Am Acad Dermatol. 2005 Feb. 52(2 Suppl 1):12-6. [Medline].

  2. Whiting DA. Chronic telogen effluvium: increased scalp hair shedding in middle-aged women. J Am Acad Dermatol. 1996 Dec. 35(6):899-906. [Medline].

  3. Perez-Mora N, Goren A, Velasco C, Bermudez F. Acute telogen effluvium onset event is associated with the presence of female androgenetic alopecia: potential therapeutic implications. Dermatol Ther. 2014 May-Jun. 27(3):159-62. [Medline].

  4. Headington JT. Telogen effluvium. New concepts and review. Arch Dermatol. 1993 Mar. 129(3):356-63. [Medline].

  5. Cartwright T, Endean N, Porter A. Illness perceptions, coping and quality of life in patients with alopecia. Br J Dermatol. 2009 May. 160(5):1034-9. [Medline].

  6. Schmidt S, Fischer TW, Chren MM, Strauss BM, Elsner P. Strategies of coping and quality of life in women with alopecia. Br J Dermatol. 2001 May. 144(5):1038-43. [Medline].

  7. Jain N, Doshi B, Khopkar U. Trichoscopy in alopecias: diagnosis simplified. Int J Trichology. 2013 Oct. 5(4):170-8. [Medline]. [Full Text].

  8. Hadshiew IM, Foitzik K, Arck PC, Paus R. Burden of hair loss: stress and the underestimated psychosocial impact of telogen effluvium and androgenetic alopecia. J Invest Dermatol. 2004 Sep. 123(3):455-7. [Medline].

  9. Peters EM, Liotiri S, Bodo E, et al. Probing the effects of stress mediators on the human hair follicle: substance P holds central position. Am J Pathol. 2007 Dec. 171(6):1872-86. [Medline].

  10. Padovese V, Racalbuto V, Barnabas GA, Morrone A. Operational research on the correlation between skin diseases and HIV infection in Tigray region, Ethiopia. Int J Dermatol. 2015 Oct. 54 (10):1169-74. [Medline].

  11. Barcaui CB, Gonçalves da Silva AM, Sotto MN, Genser B. Stem cell apoptosis in HIV-1 alopecia. J Cutan Pathol. 2006 Oct. 33(10):667-71. [Medline].

  12. Freinkel RK, Freinkel N. Hair growth and alopecia in hypothyroidism. Arch Dermatol. 1972 Sep. 106(3):349-52. [Medline].

  13. Goette DK, Odom RB. Alopecia in crash dieters. JAMA. 1976 Jun 14. 235(24):2622-3. [Medline].

  14. Kantor J, Kessler LJ, Brooks DG, Cotsarelis G. Decreased serum ferritin is associated with alopecia in women. J Invest Dermatol. 2003 Nov. 121(5):985-8. [Medline].

  15. Trost LB, Bergfeld WF, Calogeras E. The diagnosis and treatment of iron deficiency and its potential relationship to hair loss. J Am Acad Dermatol. 2006 May. 54(5):824-44. [Medline].

  16. Malkud S. A Hospital-based Study to Determine Causes of Diffuse Hair Loss in Women. J Clin Diagn Res. 2015 Aug. 9 (8):WC01-4. [Medline].

  17. Olsen EA, Reed KB, Cacchio PB, Caudill L. Iron deficiency in female pattern hair loss, chronic telogen effluvium, and control groups. J Am Acad Dermatol. 2010 Dec. 63(6):991-9. [Medline].

  18. Brodin MB. Drug-related alopecia. Dermatol Clin. 1987 Jul. 5(3):571-9. [Medline].

  19. Wise RP, Kiminyo KP, Salive ME. Hair loss after routine immunizations. JAMA. 1997 Oct 8. 278(14):1176-8. [Medline].

  20. Katz KA, Cotsarelis G, Gupta R, Seykora JT. Telogen effluvium associated with the dopamine agonist pramipexole in a 55-year-old woman with Parkinson's disease. J Am Acad Dermatol. 2006 Nov. 55(5 Suppl):S103-4. [Medline].

  21. Tosti A, Piraccini BM, van Neste DJ. Telogen effluvium after allergic contact dermatitis of the scalp. Arch Dermatol. 2001 Feb. 137(2):187-90. [Medline].

  22. Sinclair R, Jolley D, Mallari R, Magee J. The reliability of horizontally sectioned scalp biopsies in the diagnosis of chronic diffuse telogen hair loss in women. J Am Acad Dermatol. 2004 Aug. 51(2):189-99. [Medline].

  23. Rebora A, Guarrera M, Baldari M, Vecchio F. Distinguishing androgenetic alopecia from chronic telogen effluvium when associated in the same patient: a simple noninvasive method. Arch Dermatol. 2005 Oct. 141(10):1243-5. [Medline].

  24. Ross EK, Vincenzi C, Tosti A. Videodermoscopy in the evaluation of hair and scalp disorders. J Am Acad Dermatol. 2006 Nov. 55(5):799-806. [Medline].

 
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Telogen effluvium secondary to hypothyroidism.
 
 
 
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