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Telogen Effluvium
Aka: Telogen Effluvium
- See Also
- Alopecia
- Definition
- Non-scarring, non-inflammatory Alopecia involving altered hair cycle
- Epidemiology
- No gender or age predominance
- Pathophysiology
- Altered growth cycle where Telogen phase predominates
- After inciting event, a large number of hairs enter Telogen phase (and are lost months later)
- Timing
- Onset sudden, 2-4 months after inciting event
- Resolves months after causative factor resolves
- Symptoms
- Typically no systemic symptoms at time of Hair Loss (but history of trigger 2-4 months prior)
- Increased Hair Loss with brushing or showering
- Loss of 100-300 hairs per day
- Affects scalp, axillary and pubic hair
- Signs
- Uniform hair thinning
- Hair pluck test
- More than 4-6 hairs pulled
- Hairs in Telogen phase approach 50% (normally <15%)
- Consider work-up if >70% in Telogen phase
- Causes
- Endocrine disorders
- Hypothyroidism
- Hyperthyroidism
- Nutritional Disorders
- Severe Iron Deficiency Anemia
- Crash dieting or significant dietary limitations (Malnutrition)
- Zinc Deficiency
- Stressors
- Severe chronic illness (liver disease or renal disease)
- Significant acute infection (high fever)
- Postpartum effluvium
- Major surgery
- Serious psychological stressors
- Medications
- Heparin and other Anticoagulants
- Heavy Metals
- Etretinate (Tegison) and other Retinoids
- Anticonvulsants
- Antithyroid Drugs (e.g. Methimazole, PTU)
- Hormonal agents
- Oral Contraceptive discontinuation
- Alkylating Agents
- Lithium
- Antihypertensives
- Beta Blockers
- ACE Inhibitors
- Differential diagnosis
- Early Androgenetic Alopecia
- Syphilis (consider if regrowth delayed)
- Associated Conditions
- Comorbid Androgenetic Alopecia is often present
- Labs: Optional
- Thyroid Stimulating Hormone (TSH)
- Serum Iron and Serum Ferritin
- Comprehensive panel (chem18 with Serum Creatinine and Liver Function Tests)
- Management
- No treatment is needed in most cases (typically resolves spontaneously in 2-6 months)
- Treat underlying cause
- Eliminate suspected medication causes
- Consider labs as above
- Consider empiric 2 weeks of supplemental zinc if nuitritional deficiency suspected
- Course
- Typically self limited
- Resolves in 2 to 6 months spontaneously in most cases
- References
- Phillips (2017) Am Fam Physician 96(6): 371-8 [PubMed]
- Sperling (1998) Med Clin North Am 82:1155-69 [PubMed]
- Springer (2003) Am Fam Physician 68(1):93-102 [PubMed]