Telogen effluvium is one of the most common causes of hair loss and is characterized by excessive shedding of resting or telogen hair. The shedding of hair is usually temporary and associated with an insult or stressor that can be physical, mental or chemical. Let us take a look at the presentation, diagnosis and treatment options for telogen effluvium:

Presentation of Telogen Effluvium:

Telogen effluvium usually presents with a diffuse pattern of shedding or hair loss. More hair is noticed falling while washing or combing of the hair and/or more hair is noticed in the drain or on the pillow. It affects both males and females of all age groups, with a higher incidence reported in females in their middle ages. Acute telogen effluvium has a history of hair shedding that lasts for less than 6 months and is generally associated with a stressor/trigger that occurred two to three months before. It is usually self-limiting and hair growth will resolve to normal after 6 to 12 months. A good example is telogen gravidarum, which is an acute hair loss two to five months after childbirth. Chronic telogen effluvium is associated with the shedding of hair lasting for more than 6 months and might involve multiple or repetitive triggers.

Telogen effluvium is caused by an abnormality in the normal hair cycle. A normal hair life cycle has three phases:

Growing phase (Anagen phase)

Involuting phase (Catagen phase)

Resting phase (Telogen phase)

The anagen phase lasts for two to five years and around 85% – 90% of the scalp hair is in this growing phase.

The catagen phase is much shorter and lasts three to six weeks and is when the hair follicles go through a process of programmed cell death known as apoptosis.

The telogen phase lasts for about three to five months and about 10% – 15% of the scalp hair is in this resting phase.

It is normal to lose up to 100 – 150 hairs a day as a result of the normal scalp cycle. Excessive shedding of hair is experienced if the percentage of hair in the telogen phase increases. Thus, paradoxically, with telogen effluvium, hair loss is a sign of hair regrowth.

Telogen Effluvium

Numerous triggering factors can initiate a disturbance in the normal hair cycle:

Medication: The hair loss usually starts after 12 weeks of starting the medication or changing the dosage of the medication. Medications that can cause telogen effluvium include antihypertensives, antidepressants and oral contraceptives.

Physical stress/trauma: Surgery (including post hair transplant surgery), chronic illness, infection, high fever, haemorrhage and childbirth can cause telogen effluvium.

Emotional stress

Medical conditions such as thyroid disorders, autoimmune disorders and inflammatory disorders.

Dietary factors/deficiencies: Excessive weight loss, chronic starvation, calorie restriction, eating disorders and deficiencies in zinc, iron, vitamin B, vitamin D or folic acid can lead to telogen effluvium.

Stress hair loss


Examination of the scalp shows diffuse thinning (involves the entire scalp) and no patches/focal areas of hair loss can be identified.

The complaint of diffuse hair loss can be associated with tenderness, pain, burning, itching or stinging (trichodynia).

A gentle hair pull test reveals an increased number of hairs.

Modified wash test and hair loss count.

Trichogram – will show a high percentage of telogen hairs.

Microscopy will show numerous short new hairs with no variability in density.

Scalp biopsy (rarely needed) to determine the ratio of anagen to telogen hairs.

Treatment options

Patient education is important in managing telogen effluvium. Gentle handling of the hair is recommended, as well as avoiding chemical and heat treatments that could harm the hair.

Acute telogen effluvium can usually be resolved by removing the underlying cause. In the case where a measurable deficiency is identified, it should be corrected. Treat any underlying scalp disorder or hormonal problem (if any). Correct any abnormality in thyroid function, iron levels, vitamin B12 and vitamin D.

A balanced/nutritious diet with plenty of protein, fruit and vegetables is important. Supplementation may be suggested for a limited period of time while your nutritional condition improves.

Emotional stress and anxiety should be addressed/managed.

(Cited 25/05/2022)

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