Telogen Effluvium
Telogen effluvium (TE) is an acute or chronic, non-scarring form of hair loss marked by diffuse shedding across the entire scalp. It happens when a large number of follicles in the growth phase (anagen) are suddenly pushed all at once into the resting phase (telogen).
At its core, telogen effluvium is a disruption of the hair follicle's natural growth cycle:
- A shift in the follicle cycle: Normally about 85–90% of scalp follicles are in anagen (lasting 2–6 years) and 10–15% are in telogen (lasting 2–3 months). After a major physical or emotional stressor, as many as 30–50% of anagen follicles can be forced into telogen early.
- A 2–3 month delay: Because the telogen phase lasts about 8–12 weeks before the hair leaves the follicle, heavy shedding does not start right away when the triggering event happens, but only about 2–3 months later.
- Common triggers:
- Physical illness or injury: Prolonged high fever (dengue, influenza, COVID-19), major surgery, severe trauma or acute infection.
- Sudden hormonal changes: The rapid drop in estrogen after childbirth (postpartum telogen effluvium), stopping oral contraceptives, or thyroid dysfunction (hypothyroidism or hyperthyroidism).
- Acute or chronic nutritional deficiency: Low iron stores (reduced serum ferritin), low zinc, vitamin D or vitamin B12, or crash weight-loss programs and overly strict diets.
- Psychological stress: Acute or chronic emotional stress triggers the release of neuropeptides (substance P) and cortisol, causing inflammation around the follicle and pushing hairs into telogen.
- Medication side effects: Anticoagulants, oral retinoids, beta-blockers and antidepressants.
At Haute-Derma, our approach to telogen effluvium focuses on pinpointing the original trigger, screening for systemic micronutrient deficiencies, calming low-grade scalp inflammation and getting follicles back into anagen as quickly as possible.
Clinical Features and Differential Diagnosis
Examining a patient with diffuse hair loss calls for a careful look at the shedding pattern and a few simple in-office tests:
- Diffuse shedding across the whole scalp: Hair is lost evenly from every area (front, crown, temples, nape), quite unlike the localized M-shaped or crown pattern of androgenetic alopecia. Patients are often alarmed to see large amounts of hair coming out when washing or brushing, or scattered on the pillow.
- Strongly positive hair pull test: When the doctor gently grasps and pulls a bundle of about 50–60 hairs at several sites on the scalp, more than 6 hairs come out easily and painlessly.
- Shed hairs are club hairs: Under the microscope or even to the naked eye, the root has the small, round, white bulb typical of telogen, with none of the moist root sheath seen on anagen hairs.
- Trichoscopy (scalp dermoscopy):
- Overall hair density is reduced, but hair shaft diameter varies little (there is no follicular miniaturization as seen in AGA).
- Follicular openings remain clear, with many short, upright regrowing hairs emerging from recovering follicles.
- Classification by duration:
- Acute telogen effluvium: Shedding lasts less than 6 months and usually settles on its own once the trigger is dealt with.
- Chronic telogen effluvium (CTE): Shedding is persistent or comes in waves for more than 6 months. It is most common in middle-aged women and usually reflects several contributing factors that have not been fully addressed.
Haute-Derma's Approach to Diagnosis and Treatment
- Finding the cause with comprehensive blood work: We perform trichoscopy together with a pull test, then order a targeted blood panel to track down the cause: serum ferritin (iron stores), thyroid function (TSH, FT4), micronutrients (zinc, vitamin D3, B12) and a complete blood count.
- Removing triggers and providing reassurance: We build a plan to address the root causes (replacing missing nutrients, adjusting medications that cause shedding, controlling endocrine disease). Reassurance matters too: the doctor helps patients understand that this hair loss is temporary and does not permanently damage the follicles.
- Follicle stimulation to restore anagen:
- Mesotherapy: Growth peptides, biotin, amino acids, coenzymes and B-complex vitamins are delivered directly into the scalp dermis to nourish weakened dermal papillae.
- Platelet-rich plasma (PRP) / PRF: Your own growth factors (VEGF, PDGF, FGF) are released to stimulate new blood vessel formation around the follicles and speed their return to anagen.
- Low-level laser therapy (LLLT): Improves microcirculation in the scalp and stimulates cellular mitochondria to produce ATP.
- Home care and nutritional recovery: We advise on gentle, pH-balanced shampoos and limiting heat styling, bleaching and dyeing during the acute shedding phase. We also set up a protein-rich diet (especially L-cystine) and recommend hair-specific micronutrient supplements at medically appropriate doses.
Comparing Common Types of Hair Loss
| Acute Telogen Effluvium (Acute TE) | Chronic Telogen Effluvium (Chronic TE) | Androgenetic Alopecia (AGA) |
|---|---|---|
| < 6 months (usually peaks 2–3 months after the trigger). | Lasts > 6 months, with persistent waves of shedding. | Gradual onset with continuous, chronic progression. |
| Even, diffuse loss of density over the whole scalp. | Diffuse loss of density, most noticeable at both temples. | Localized to the frontal hairline (M-shape) or crown. |
| Uniform hair diameter, no miniaturization. | Slightly reduced hair diameter, no obvious miniaturization. | Variable hair diameter (>20% fine, vellus-like hairs). |
| Full recovery once the cause is removed. | Slow recovery; hidden causes need to be controlled. | Needs ongoing maintenance treatment to prevent progression. |
