Telogen effluvium – eng

Telogen effluvium is a very common and complex hair condition which affects all age groups, and women more often than men. After androgenetic alopecia this is the second most common cause of hair loss and the second most common reason people go to a doctor for help.


What is the physiological mechanism behind this condition?


te-3It is normal for around 80-90% of the hair to be in the anagen (active) growth phase, while the remainder is in the so-called telogen (passive) growth phase. In telogen effluvium, a large number of hairs can simultaneously and unexpectedly enter this passive growth and loss phase. It most often affects the middle of the head, more rarely the temporal (side) and occipital (back) areas. Patients usually do not lose all their hair, but it becomes diffusely thinner and weaker, and often the scalp can clearly be seen. Typically hair loss can be seen temporally along the hairline (similar to male receding corners) and female patients will give their subjective impression that their ponytail has lost volume. In more severe cases, telogen effluvium also affects the eyebrows and pubic and underarm hair. The hair follicles are not permanently damaged, it is just that more of them are in the passive growth stage than is normal. For this reason, the sooner therapy is begun, the more chance there is of slowing or halting the hair loss and returning the hair to the active growth phase. There are two forms this disorder takes: in one, the hair loss comes about suddenly, and most of the hair is lost in the first two months after telogen effluvium appears (the acute form); the other, in which hair is gradually lost, takes longer to enter the passive growth stage, and so hair loss persists for around 6-8 months (the chronic form), after which it recedes.


Why does telogen effluvium happen?


teThere are a great number of different factors which can cause this condition. Classic telogen effluvium happens after childbirth. This is because the estrogens that are released in large quantities during the 9 months of pregnancy have a very positive effect on hair growth, and extend the anagen (active) growth phase of the hair. After childbirth the release of estrogen is slowed, and the hair, which had benefited from this hormone during pregnancy, now enters the passive phase. Every hair that was supposed to have fallen out on schedule during the course of nine months suddenly falls out, leading to telogen effluvium. Most women get over this within a couple of months, and their hair regains its volume.


Diets can also cause hair loss. We need to keep in mind that any loss of weight will be accompanied by hair loss. This is why we need to plan ahead and take the necessary supplements to help our hair during the diet. Sometimes hair can also fall out when we gain weight.


Certain medications can cause chronic telogen effluvium – such as antidepressants, beta blockers, and it can also occur after receiving a vaccine or undergoing a surgical procedure.


Probably the most common cause behind TE today is stress (acute, chronic, repressed or manifested), whereby the hair reacts as a weak point (locus minoris resistentiae – place of less resistance). Chronic illness and a lack of certain vitamins and minerals in the body are also causes of this disease.


It is important to realise that telogen effluvium can come in tandem with other conditions that lead to hair loss, most often with androgenetic alopecia and alopecia areata.


te-2After proper diagnosis (taking patient history, examination of the hair, pull test, dermatoscopy, trichoscopy and sometimes biopsy), a therapy needs to be tailored to the lifestyle of each patient. Basic therapy involves the use of minoxidil (a lotion registered for hair loss treatment), with careful application in order to avoid the growth of hair on the face, and proper dosing (a 2% solution is prescribed). Minoxidil must not be used during pregnancy or breastfeeding. Should the patient opt for treatment with finasteride, she must use a contraceptive. Melatonin has an important role to play in the treatment of telogen effluvium. Newer therapies also involve the use of a laser. There are lasers both for clinical use and for home use. I Grow – a laser intended for home use – is a major technological leap in the treatment of alopecia, and is very practical. Therapy is carried out at home, according to a specific protocol. The laser light stimulates the follicles to “wake up” and return to the active growth phase. PRP – therapy using platelet-rich plasma and growth factors – is currently the hot topic as far as innovations in alopecia treatment are concerned. The patient’s own growth factors are injected into the scalp, and these migrate to the follicles and prompt them to enter the active growth phase. The therapy is carried out at the clinic, and depending on the extent of the telogen effluvium, either one or three treatments are carried out. The results can be seen as soon as two months after the first application. Hair transplantation is not performed as long as there is active hair loss.


Patients need to be aware that treatment of telogen effluvium is not straightforward, and great perseverance is required with every therapy that is implemented. The encouraging news is that these therapies give excellent results in the majority of cases, and so it is important to develop trust both in your physician, who will lead you through the therapy, and in the therapy itself. This will also reduce levels of the stress which you are no doubt experiencing as a result of this disorder.


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