eMedicine Specialties > Dermatology > Diseases of the Adnexa

Telogen Effluvium: Treatment & Medication

Author: Elizabeth CW Hughes, MD, Dermatologist, Group Health Cooperative
Contributor Information and Disclosures

Updated: Mar 27, 2009

Treatment

Medical Care

  • Because acute telogen effluvium is a reactive process, which resolves spontaneously, treatment usually is limited to reassurance.
  • While chronic telogen effluvium is less likely to resolve rapidly, reassurance is appropriate for these patients. Often, the knowledge that the hair loss will not progress to baldness is comforting to the patient. The patient should be encouraged to style the hair in a way that masks any perceived defects in hair density.
  • Any reversible cause of hair shedding, such as poor diet, iron deficiency, hypothyroidism, or medication use, should be corrected.
  • While topical minoxidil is not proven to promote recovery of hair in telogen effluvium, this medication has a theoretical benefit and is well tolerated. Patients who are eager to play an active role in their treatment may choose to use minoxidil.

Surgical Care

Hair transplantation is not an effective treatment for telogen effluvium.

Diet

If an unbalanced diet is believed to be a contributing factor to telogen effluvium, especially in a case of chronic telogen effluvium, consultation with a dietitian may be extremely helpful. The dietary consultation should focus on adequate protein intake, replenishing low iron stores, and obtaining essential nutrients. If the patient takes large doses of vitamin A, this practice should be stopped.

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Vasodilators

Mechanism of action in the treatment of telogen effluvium is unknown.


Minoxidil (Loniten, Rogaine)

Relaxes arteriolar smooth muscle, causing vasodilation; hair growth effects are secondary to vasodilation.

Adult

Apply 1 mL bid; 10-40 mg/d PO qd or divided bid; not to exceed 100 mg/d

Pediatric

Not established

Concurrent use with guanethidine, diuretics, or hypotensive agents may result in additive hypotension

Documented hypersensitivity; pheochromocytoma

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

May exacerbate angina pectoris; caution in pulmonary hypertension, congestive heart failure, coronary artery disease, and significant renal failure

More on Telogen Effluvium

Overview: Telogen Effluvium
Differential Diagnoses & Workup: Telogen Effluvium
Treatment & Medication: Telogen Effluvium
Follow-up: Telogen Effluvium
Multimedia: Telogen Effluvium
References
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References

  1. Sinclair R. Chronic telogen effluvium: a study of 5 patients over 7 years. J Am Acad Dermatol. Feb 2005;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. Dec 1996;35(6):899-906. [Medline].

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

  4. 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. Sep 2004;123(3):455-7. [Medline].

  5. 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. Dec 2007;171(6):1872-86. [Medline].

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

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

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

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

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

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

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

  13. 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. Nov 2006;55(5 Suppl):S103-4. [Medline].

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

  15. 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. Aug 2004;51(2):189-99. [Medline].

  16. 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. Oct 2005;141(10):1243-5. [Medline].

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

  18. Camacho F. Alopecias due to telogen effluvium. In: Camacho F, Montagna W, eds. Trichology: Diseases of the Pilosebaceous Follicle. Madrid, Spain: Aula Medica Group; 1993:403-10.

  19. Kligman AM. Pathologic dynamics of human hair loss. I. Telogen effuvium. Arch Dermatol. Feb 1961;83:175-98. [Medline].

  20. Rushton DH. Management of hair loss in women. Dermatol Clin. Jan 1993;11(1):47-53. [Medline].

  21. Rushton DH, Ramsay ID, James KC, Norris MJ, Gilkes JJ. Biochemical and trichological characterization of diffuse alopecia in women. Br J Dermatol. Aug 1990;123(2):187-97. [Medline].

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Further Reading

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Keywords

telogen effluvium, chronic telogen effluvium, nonscarring alopecia, alopecia, hair loss, acute hair loss, non-scarring alopecia, balding

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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 and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

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, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

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