Causes and Management of Telogen Effluvium
Telogen effluvium is primarily caused by physiological or psychological stressors that disrupt the normal hair cycle, resulting in excessive shedding of telogen hairs. Management should focus on identifying and addressing the underlying cause while providing supportive treatments to promote hair regrowth.
Causes of Telogen Effluvium
Physiological Stressors
- Nutritional deficiencies:
- Zinc deficiency (significantly lower levels found in patients with chronic telogen effluvium) 1
- Iron deficiency (particularly in women)
- Vitamin D deficiency
- Protein malnutrition
Psychological Stressors
- Emotional stress and anxiety
- Major life events (divorce, bereavement, etc.)
- Chronic psychological stress
Medical Conditions
- Thyroid disorders (both hypo- and hyperthyroidism)
- Systemic illnesses
- Inflammatory conditions
- Infectious diseases
Medications
- Systemic retinoids 2
- Antifungal agents 2
- Psychotropic medications 2
- Anticoagulants 3
- Antihypertensive medications 3
- B-Raf inhibitors (can cause telogen effluvium as a side effect) 4
Other Causes
- Recent childbirth (postpartum telogen effluvium)
- Major surgery or trauma
- Rapid weight loss
- Hormonal changes
Diagnostic Approach
Clinical Features
- Diffuse hair shedding (>100 hairs/day)
- Positive hair pull test (>10% telogen hairs)
- No visible scalp inflammation
- Hair loss typically occurs 2-3 months after the triggering event
- Trichodynia (scalp pain) may be present
Investigations
- Laboratory tests to rule out underlying causes:
Diagnostic Tests
- Hair pull test
- Trichogram
- Phototrichogram
- Scalp biopsy (if diagnosis is uncertain) 5
Management
Primary Approach
Identify and remove the triggering factor:
- Discontinue suspected medications if possible
- Treat underlying medical conditions
- Address nutritional deficiencies
- Manage psychological stressors
Nutritional supplementation when deficiencies are identified:
- Zinc supplementation if deficient 1
- Iron supplementation if ferritin is low
- Vitamin D if deficient
Pharmacological Treatment
Oral minoxidil (0.25-2.5 mg daily):
Topical minoxidil:
- 2% or 5% solution applied twice daily
- May stimulate hair regrowth
Corticosteroids:
- May be considered in inflammatory cases
- Short courses of oral corticosteroids or intralesional injections
Novel Treatments
- CNPDA (caffeine, niacinamide, panthenol, dimethicone, and acrylate polymer) 5
Patient Education
- Explain the temporary nature of the condition (typically resolves within 6-12 months after removing the trigger)
- Reassure that complete baldness is rare
- Advise gentle hair care practices:
- Avoid harsh chemical treatments
- Minimize heat styling
- Use gentle shampoos
- Avoid tight hairstyles that pull on the hair
Follow-up
- Regular monitoring every 3-6 months
- Assess hair shedding using standardized methods (hair count, photography)
- Adjust treatment based on response
Special Considerations
Chronic Telogen Effluvium
- Persists beyond 6 months
- May require more aggressive treatment approaches
- Consider oral minoxidil if other treatments fail 6
Medication-Induced Telogen Effluvium
- Typically occurs 2-4 months after starting medication
- Resolution usually begins 3-6 months after discontinuation
- If medication cannot be stopped, consider supportive treatments
Postpartum Telogen Effluvium
- Self-limiting condition
- Typically resolves within 6-12 months without specific treatment
- Nutritional support may accelerate recovery
Telogen effluvium generally has a good prognosis with appropriate management of the underlying cause, though chronic cases may require longer treatment periods and more comprehensive approaches.