Telogen Effluvium

Aka: Telogen Effluvium

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II. Definition

  1. Non-scarring, non-inflammatory Alopecia involving altered hair cycle

III. Epidemiology

  1. No gender or age predominance

IV. Pathophysiology

  1. Altered growth cycle where Telogen phase predominates
    1. After inciting event, a large number of hairs enter Telogen phase (and are lost months later)
  2. Timing
    1. Onset sudden, 2-4 months after inciting event
    2. Resolves months after causative factor resolves

V. Symptoms

  1. Typically no systemic symptoms at time of Hair Loss (but history of trigger 2-4 months prior)
  2. Increased Hair Loss with brushing or showering
  3. Loss of 100-300 hairs per day
  4. Affects scalp, axillary and pubic hair

VI. Signs

  1. Uniform hair thinning
  2. Hair pluck test
    1. More than 4-6 hairs pulled
    2. Hairs in Telogen phase approach 50% (normally <15%)
    3. Consider work-up if >70% in Telogen phase

VII. Causes

  1. Endocrine disorders
    1. Hypothyroidism
    2. Hyperthyroidism
  2. Nutritional Disorders
    1. Severe Iron Deficiency Anemia
    2. Crash dieting or significant dietary limitations (Malnutrition)
    3. Zinc Deficiency
  3. Stressors
    1. Severe chronic illness (liver disease or renal disease)
    2. Significant acute infection (high fever)
    3. Postpartum effluvium
    4. Major surgery
    5. Serious psychological stressors
  4. Medications
    1. Heparin and other Anticoagulants
    2. Heavy metals
    3. Etretinate (Tegison) and other retinoids
    4. Anticonvulsants
    5. Antithyroid Drugs (e.g. Methimazole, PTU)
    6. Hormonal agents
    7. Oral Contraceptive discontinuation
    8. Alkylating Agents
    9. Lithium
    10. Antihypertensives
      1. Beta Blockers
      2. ACE Inhibitors

VIII. Differential diagnosis

  1. Early Androgenetic Alopecia
  2. Syphilis (consider if regrowth delayed)

IX. Associated Conditions

  1. Comorbid Androgenetic Alopecia is often present

X. Labs: Optional

  1. Thyroid Stimulating Hormone (TSH)
  2. Serum Iron and Serum Ferritin
  3. Comprehensive panel (chem18 with Serum Creatinine and Liver Function Tests)

XI. Management

  1. No treatment is needed in most cases (typically resolves spontaneously in 2-6 months)
  2. Treat underlying cause
  3. Eliminate suspected medication causes
  4. Consider labs as above
  5. Consider empiric 2 weeks of supplemental zinc if nuitritional deficiency suspected

XII. Course

  1. Typically self limited
    1. Resolves in 2 to 6 months spontaneously in most cases

XIII. References

  1. Phillips (2017) Am Fam Physician 96(6): 371-8 [PubMed]
  2. Sperling (1998) Med Clin North Am 82:1155-69 [PubMed]
  3. Springer (2003) Am Fam Physician 68(1):93-102 [PubMed]

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Ontology: Telogen effluvium (C0263518)

Definition (NCI) A scalp hair loss condition characterized by excessive shedding of hair in the resting phase of growth, usually following a fever or major body stress.(NICHD)
Concepts Disease or Syndrome (T047)
ICD9 704.02
ICD10 L65.0
SnomedCT 201147004, 39479004
English telogen effluvium (diagnosis), telogen effluvium, Telogen Effluvium, Telogen effluvium (disorder), effluvium; telogen, telogen; effluvium, Telogen effluvium
German Telogeneffluvium, Telogen effluvium
Korean 휴지기 탈모
Czech Telogenní alopecie
Dutch telogeen effluvium, effluvium; telogeen, telogeen; effluvium, Telogeen effluvium
French Effluves télogènes
Hungarian Telogen effluvium
Italian Telogen effluvio
Japanese ｷｭｳｼｷﾀﾞﾂﾓｳ, 休止期脱毛
Portuguese Eflúvio telogénico
Spanish Efluvio telógeno, efluvio telógeno (trastorno), efluvio telógeno, efluvium telógeno
Derived from the NIH UMLS (Unified Medical Language System)

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