Telogen effluvium is a scalp disorder characterized by the thinning or shedding of hair resulting from the early entry of hair in the telogen phase. It is in this phase that telogen hairs begin to shed at an increased rate, where normally the approximate rate of hair loss is 125 hairs per day.

Telogen effluvium is a scalp disorder characterized by the thinning or shedding of hair resulting from the early entry of hair in the telogen phase (the resting phase of the hair follicle).[1][2][3] It is in this phase that telogen hairs begin to shed at an increased rate, where normally the approximate rate of hair loss (having no effect on one's appearance) is 125 hairs per day.[4]

There are 5 potential alterations in the hair cycle that could lead to this shedding: immediate anagen release, delayed anagen release, short anagen syndrome, immediate telogen release, and delayed telogen release.[4][5]

  • Immediate anagen release occurs when follicles leave anagen and are stimulated to enter telogen prematurely. The effects become visible 2–3 months later with increased telogen effluvium.
  • Delayed anagen release, most commonly associated with pregnancy, involves the prolongation of anagen under the effect of pregnancy hormones, resulting in delayed but synchronous and heavy postpartum hair shedding.
  • Short anagen syndrome is characterized by an idiopathic and persistent telogen hair shedding, as well as the inability to grow hair long. This is a result of the shortening of the duration of anagen, meaning a greater number of telogen hairs at any given time, and is responsible for the majority of chronic TE cases.
  • Immediate telogen release generally occurs with drug-induced shortening of telogen leading to the premature reentrance of follicles to anagen, which causes a massive release of club (telogen) hairs. Drugs such as minoxidil can precipitate immediate telogen release.
  • Delayed telogen release involves a prolonged telogen phase followed by a delayed transition to anagen. This occurs in animals with synchronous hair cycles that shed their hair or winter coats seasonally. This is also sometimes responsible for seasonal hair loss in humans.[4][5][6]

Emotional or physiological stress may result in an alteration of the normal hair cycle and cause the disorder, with potential causes including eating disorders, crash diets, pregnancy and childbirth, chronic illness, major surgery, anemia, severe emotional disorders, hypothyroidism, and drugs.[1][7]

COVID-19 vaccination has also been reported as a trigger for telogen effluvium, with immune-mediated disruption of the hair follicle cycle proposed as the underlying mechanism. Regenerative approaches including autologous stem cell therapy have been investigated as potential treatments for vaccine-associated hair loss.[8]


Diagnostic tests, which may be performed to verify the diagnosis, include a trichogram, trichoscopy[9] and biopsy.[7] Effluvium can present with similar appearance to alopecia totalis, with further distinction by clinical course, microscopic examination of plucked follicles, or biopsy of the scalp.[10] Histology would show telogen hair follicles in the dermis with minimal inflammation in effluvium, and dense peribulbar lymphocytic infiltrate in alopecia totalis.[11]

Vitamin D levels may also play a role in the normal hair cycle.[12]

Many new cosmetic treatments have been reported, including Stemoxydine, Nioxin, minoxidil, and a leave-on technology combination: caffeine, niacinamide, panthenol, dimethicone, and an acrylate polymer (CNPDA). This treatment has shown to increase the diameter of existing, individual scalp hair fibres by 2–5 μm, yielding a significant increase of approximately 10% in the cross-sectional area of each hair. Additionally, CNPDA-thickened hairs also demonstrate altered mechanical properties of thicker fibres; increased suppleness/pliability, and increased ability to withstand force without breaking.[13][citation needed]

See also

  • Anagen effluvium
  • Noncicatricial alopecia

References

  1. 1 2 Marks, James G; Miller, Jeffery (2006). Lookingbill and Marks' Principles of Dermatology (4th ed.). Elsevier Inc. Page 263. ISBN 1-4160-3185-5.
  2. ↑ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
  3. ↑ Asghar, Fahham; Shamim, Nazia; Farooque, Umar; Sheikh, Haris; Aqeel, Ramsha (2020). "Telogen Effluvium: A Review of the Literature". Cureus. 12 (5) e8320. doi:10.7759/cureus.8320. PMC 7320655. PMID 32607303.
  4. 1 2 3 Khan Mohammad Beigi, Pooya (2018). "Introduction". In Khan Mohammad Beigi, Pooya (ed.). Alopecia Areata: A Clinician's Guide. Springer International Publishing. pp. 3–5. doi:10.1007/978-3-319-72134-7_1. ISBN 978-3-319-72134-7.
  5. 1 2 Liyanage, Deepa; Sinclair, Rodney (2016-03-25). "Telogen Effluvium". Cosmetics. 3 (2): 13. doi:10.3390/cosmetics3020013. ISSN 2079-9284.
  6. ↑ Grover, Chander; Khurana, Ananta (2013). "Telogen effluvium". Indian Journal of Dermatology, Venereology and Leprology. 79 (5): 591–603. doi:10.4103/0378-6323.116731. ISSN 0378-6323. PMID 23974577.
  7. 1 2 Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
  8. ↑ Kim, Suyeon (2026). "Stem cell therapy alleviates hair loss caused by COVID-19 vaccination". Journal of Exercise Rehabilitation. 22 (2): 66–70. doi:10.12965/jer.2652242.121.
  9. ↑ Rudnicka L, Olszewska M, Rakowska A, Kowalska-Oledzka E, Slowinska M (2008). "Trichoscopy: a new method for diagnosing hair loss". J Drugs Dermatol. 7 (7): 651–654. PMID 18664157.
  10. ↑ Werner, B.; Mulinari-Brenner, F. (2012). "Clinical and histological challenge in the differential diagnosis of diffuse alopecia: Female androgenetic alopecia, telogen effluvium and alopecia areata – part II". Anais Brasileiros de Dermatologia. 87 (6): 884–890. doi:10.1590/S0365-05962012000600010. PMC 3699921. PMID 23197208.
  11. ↑ Alkhalifah, A. (2012). "Alopecia Areata Update". Dermatologic Clinics. 31 (1): 93–108. doi:10.1016/j.det.2012.08.010. PMID 23159179.
  12. ↑ Amor KT, Rashid RM, Mirmirani P (2010). "Does D matter? The role of vitamin D in hair disorders and hair follicle cycling". Dermatol. Online J. 16 (2): 3. doi:10.5070/D38S34P6B7. PMID 20178699.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. ↑ Davis, M.G.; Thomas, J.H.; van de Velde, S.; Boissy, Y.; Dawson, T.L.; Iveson, R.; Sutton, K. (December 2011). "A novel cosmetic approach to treat thinning hair". British Journal of Dermatology. 165: 24–30. doi:10.1111/j.1365-2133.2011.10633.x. ISSN 0007-0963. PMID 22171682. S2CID 21918537.
RashesWithout
epidermal
involvementNonblanchable
PurpuraIndurated
  • Scleroderma/morphea
  • Granuloma annulare
  • Lichen sclerosis et atrophicus
  • Necrobiosis lipoidica
Miscellaneous
disorders Follicular cysts
  • "Sebaceous cyst"
    • Epidermoid cyst
    • Trichilemmal cyst
  • Steatocystoma
    • simplex
    • multiplex
  • Milia
Inflammation
  • Folliculitis
    • Folliculitis nares perforans
    • Tufted folliculitis
  • Pseudofolliculitis barbae
  • Hidradenitis
    • Hidradenitis suppurativa
    • Recurrent palmoplantar hidradenitis
    • Neutrophilic eccrine hidradenitis
Ungrouped
  • Acrokeratosis paraneoplastica of Bazex
  • Acroosteolysis
  • Bubble hair deformity
  • Disseminate and recurrent infundibulofolliculitis
  • Erosive pustular dermatosis of the scalp
  • Erythromelanosis follicularis faciei et colli
  • Hair casts
  • Hair follicle nevus
  • Intermittent hair–follicle dystrophy
  • Keratosis pilaris atropicans
  • Kinking hair
  • Koenen's tumor
  • Lichen planopilaris
  • Lichen spinulosus
  • Loose anagen syndrome
  • Menkes kinky hair syndrome
  • Monilethrix
  • Parakeratosis pustulosa
  • Pili (Pili annulati
  • Pili bifurcati
  • Pili multigemini
  • Pili pseudoannulati
  • Pili torti)
  • Pityriasis amiantacea
  • Plica neuropathica
  • Poliosis
  • Rubinstein–Taybi syndrome
  • Setleis syndrome
  • Traumatic anserine folliculosis
  • Trichomegaly
  • Trichomycosis axillaris
  • Trichorrhexis (Trichorrhexis invaginata
  • Trichorrhexis nodosa)
  • Trichostasis spinulosa
  • Uncombable hair syndrome
  • Woolly hair nevus
Sweat
glands