Telogen Effluvium

Aka: Telogen Effluvium

1. See Also
   1. Alopecia
2. Definition
   1. Non-scarring, non-inflammatory Alopecia involving altered hair cycle
3. Epidemiology
   1. No gender or age predominance
4. 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
5. 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
6. 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
7. 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
8. Differential diagnosis
   1. Early Androgenetic Alopecia
   2. Syphilis (consider if regrowth delayed)
9. Associated Conditions
   1. Comorbid Androgenetic Alopecia is often present
10. Labs: Optional
    1. Thyroid Stimulating Hormone (TSH)
    2. Serum Iron and Serum Ferritin
    3. Comprehensive panel (chem18 with Serum Creatinine and Liver Function Tests)
11. 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
12. Course
    1. Typically self limited
       1. Resolves in 2 to 6 months spontaneously in most cases
13. 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]