Alopecia or Telogen Effluvium?

Hi there my beautiful lovelies! Hope you are doing well and staying safe. Today, I want to talk to you about a different type of hair loss that you may not be aware of. It’s called telogen effluvium. Today, I want to talk to you about Telogen effluvium and how it differs from alopecia.

What is Telogen effluvium?

Photo courtesy of Istanbul Hair Clinic:

Before we can talk about the similarity and differences between telogen effluvium and alopecia, we need to talk about that telogen effluvium is. Telogen effluvium is a non-scarring form of diffuse hair loss with no clinical or histological evidence of inflammation and can affect up to 50% of the scalp hair. It is the name for a common cause of temporary hair loss due to the excessive shedding of resting or telogen hair after some shock to the system. New hair continues to grow. Telogen hair is also known as club hair due to the shape of the root. The new hairs coming up through the scalp push out the resting club hairs and increased hair fall is noticed 2 to 4 months after the triggering event.

Acute telogen effluvium can affect people of all age groups and both sexes. In a normal healthy person’s scalp, about 85% of the hair follicles are actively growing hair (anagen hair) and about 15% are resting hair (telogen hair). A few hairs may also be in catagen. A hair follicle usually grows anagen hair for 4 years or so, then rests for about 4 months.  A new anagen hair begins to grow under the resting telogen hair and pushes it out. As a result, we typically lose about 100 hairs daily.

What Triggers Telogen Effluvium?

If there is some shock to the system, as many as 70% of the anagen hairs can be precipitated into telogen, thus reversing the usual ratio. Typical triggers include:

  • Childbirth: postpartum hair loss. This can resolve after a few months or transition into female pattern alopecia.
  • Physiological neonatal hair loss
  • Acute or chronic illness, especially if there is fever
  • Surgical operation
  • Accident
  • Psychological stress
  • Weight loss, unusual diet, or nutritional deficiency (eg, iron deficiency/)
  • Certain medications
  • Endocrine disorders (eg, hypothyroidism, hyperthyroidism)
  • Discontinuing the contraceptive pill
  • Overseas travel resulting in jetlag
  • Skin disease affecting the scalp (eg, erythroderma)
  • Excessive sun exposure.

Since nail and hair growth are under the same influences, an arrest in hair growth is often mirrored in the nails by a groove across them coinciding with the time of the shock to the system — a Beau line. The time of the shock can be estimated from the fact that a fingernail takes 5 months to grow from the posterior nail fold to the free edge. So if the groove in the nail is halfway down the nail, the shock must have been two and a half months ago.

Diagnosis of Telogen Effluvium

Telogen effluvium is usually diagnosed by its clinical features.

  1. Hair thinning involves the entire scalp +/- loss of other body hair.
  2. Examination shows diffuse thinning without focal areas of total alopecia and short hairs of normal thickness.
  3. A gentle hair pull test reveals an increased number of hairs; most are telogen with a typical epithelial sac.

A trichogram can help confirm the diagnosis; more than 25% telogen hairs in a trichogram strongly suggests telogen effluvium.

What Are Some of The Treatments?

Telogen effluvium is self-correcting. Recommendations include:

  • Gentle handling of the hair, avoiding over-vigorous combing, brushing and any type of scalp massage
  • Treat any underlying scalp disorder or hormonal problem determined, if any
  • Ensure a nutritious diet, with plenty of protein, fruit and vegetables.  
  • Correct any abnormality in thyroid function, or levels of iron, vitamin B12 and folic acid.

Regrowth usually occurs after removal of the trigger causing telogen effluvium. However, repeated episodes of acute telogen effluvium can sometimes evolve into female pattern hair loss.

Telogen Effluvium Vs. Alopecia:

Both telogen effluvium and alopecia cause hair loss, but the reasons and patterns for hair loss are different with each condition. A doctor can tell which one you have and how to manage it. With telogen effluvium, you might notice more hair than usual coming out when you wash or brush your hair. You may find more hair on your pillowcase. The appearance of your hair might change and look thinner all over your head. As for alopecia, women lose hair along the line of the part first. Hair around the top of the head gets thinner as well. Women’s hairlines aren’t usually affected and they seldom go completely bald. With alopecia, hair loss in men starts above the temples. The whole hairline recedes into an “M” shape. Hair at the top of the head also thins. Sometimes, total baldness occurs.

Female Pattern Baldness – Courtesy of HealthDirect Australia

Unlike telogen effluvium, the underlying cause of androgenetic alopecia is your body’s response to androgens, a type of sex hormone. There is a genetic component to the condition. You can usually identify family members who have had the same kind of hair loss.

Hope this helps you distinguish between the two types of hair loss. I have suffered from both. It was my dermatologist who has diagnosed me with telogen effluvium. Hence, please talk to your physician about the type of hair loss that you have. I would love to hear from you which one you have and how did your deal with that type of hair loss.

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