Telogen effluvium is a type of hair loss characterized by a large amount of hair shedding observed in a short span of time, triggered either by stress, some clinical conditions, or following crash diets. Telogen effluvium is usually caused as a response to periods of physiological stress in the body such as illness, childbirth, certain medications, surgery, or emotional turmoil. Telogen effluvium involves dysregulation of the hair growth cycle which causes the majority of hair follicles in the growth phase to be pushed into the shedding phase. Hence, profuse hair shedding is observed.
There are predominantly 2 subtypes of telogen effluvium such as acute and chronic telogen effluvium. The acute form involves shedding which lasts for 2-3 months from the time of encountering the trigger factor. The chronic form lasts for 6 months or more from the point of trigger factor.
Causes Of Telogen Effluvium
Telogen effluvium is a reactive process, triggered by metabolic stress, hormonal changes, or medications. Common triggering events are acute febrile illness; severe infection; major surgery; severe trauma; postpartum hormonal changes, particularly a decrease in estrogen; hypothyroidism; discontinuing estrogen-containing medication; crash dieting; low protein intake; heavy metal ingestion; and iron deficiency. Many medications have been linked to telogen effluvium, but the most common are beta-blockers, retinoids (including excess vitamin A), anticoagulants, propylthiouracil, carbamazepine, and immunizations.
Telogen effluvium can occur in people of any age, any gender, and any racial background. A large percentage of adults experience an episode of telogen effluvium at some point. Telogen effluvium can occur in either sex, though women have a greater tendency to experience this condition because of postpartum hormonal changes. Also, women are more disturbed by hair shedding than men and are therefore more likely to seek medical attention.
Tests & Symptoms Of Telogen Effluvium
The symptoms of telogen effluvium are :
- Profuse hair shedding was observed on pillows, shower drains and hair brushes, or fingers when brushed against the hair strands.
- Brittle, thin, and dry hair
- Sparse hair density
Telogen effluvium can be diagnosed through a simple examination of the scalp and taking a personal dietary and medical history. Usually, 90% of the hair follicles on the scalp are in the growth phase and at least 10% are in the telogen or shedding phase. In telogen effluvium, up to 25% of the hair follicles undergo the shedding phase which can be confirmed during a physical examination of your scalp. A pull test is conducted where a specialist or dermatologist slightly pulls small clumps of hair all over the scalp. If more than 6-8 strands of hair are shed during this process, then an active hair loss condition is confirmed. In telogen effluvium, several strands of shed hair observed are club hairs in their telogen phase with a depigmented bulb at the root of the hair strand. Your healthcare provider will also ask you about your diet and recent medical history. Medical investigators often probe into history of illness or medical history of endocrine/hormonal diseases or surgeries to identify a trigger factor for telogen effluvium in patients.
As per histologic findings in telogen effluvium, the following observations are noted in a biopsy :
- The number and density of hair follicles are usually normal, but there are a large number of hair follicles that are in the catagen or the telogen phase.
- If 25% of the follicles are in the telogen phase, the diagnosis of telogen effluvium is confirmed.
- The percentage of telogen hair should not typically be higher than 50%.
Allopathic Treatment For Telogen Effluvium
Minoxidil, a conventional treatment for hypertension, tends to open potassium channels and blood vessels, thereby allowing larger amounts of blood, nutrients, and oxygen to reach the hair follicles. Topical minoxidil is believed to shorten the telogen phase of the hair cycle, thereby compelling resting hair follicles to prematurely enter the anagen phase. It possibly extends the anagen phase and also increases the size of hair follicles.
Minoxidil plays a crucial role in the management of chronic TE (telogen effluvium), but it is not recommended in acute TE. A combination therapy of minoxidil and a peptide could produce better results in comparison to either of them being used as a monotherapy. Minoxidil has a place in TE management since it is a vasodilator that positively influences the anagen phase of the hair cycle.
Shampoos & Hair Oils
Shampoos don't have a direct role in the treatment of TE, but they shall help to clear off the accumulated sebum and debris on the scalp and hair follicles which tends to block proper oxygenation of the follicles. Avoid rough scrubbing while shampooing is recommended and a shampoo without sodium lauryl sulfate (SLS) is recommended. Even hair oils don't have a direct effect on controlling hair fall but it helps as a conditioning agent to protect the hair cuticle making it smooth and shiny. They should be used only on the shafts and not hair roots in cases of TE.
Several nutrients such as iron, zinc, vitamins A, E, C, K, D, B12, and selenium help in improving the shaft structure of hair strands and increase the number of active hair follicles. Several studies have reported a direct proportion between nutritional deficiency and TE. The adequate protein content is also equally necessary for better hair health. Supplementation by protein powders may be considered in protein-deficient patients. Dietary sources of proteins are helpful for maintaining hair health and sulfur-containing amino acids are specifically good for hair growth.
Platelet-rich plasma (PRP) is a novel treatment option for hair loss. An autologous concentration of platelets contained within a small volume of plasma is used to promote the rejuvenation of hair follicles, owing to the presence of various growth factors. Treatment outcomes of PRP are more effective in androgenic alopecia (pattern hair loss) as compared to TE.
Ayurvedic Treatment For Telogen Effluvium
Ayurveda recommends a healthy hair care routine for controlling hair loss caused due to telogen effluvium.
Also called murdha taila, regular application of medicated ayurvedic oil helps in balancing aggravated doshas and also provides deep nourishment to the hair follicles for better hair growth. Ayurvedic oils condition your hair by strengthening the cuticle and cortex of your hair fiber.
Hair Wash (Snana)
Regular hair washing up to thrice a week depending upon the degree of hair shedding is useful for keeping the scalp free of bacteria and infection. Potent herbal decoctions made of Triphala, Shikakai, Brahmi, Bhringaraj, Reetha, and Jatamansi which are all-natural hair cleansers can be used on a regular basis. Care needs to be taken by using mild, natural shampoos without harsh chemicals which can cause scalp irritation.
Shiro Abhyanga (Head Massage)
Scalp massage with medicated hair oils with a systematic massage sequence of the neck, shoulders, spine, and scalp helps in increasing blood circulation to the scalp region and controlling TE.
Hair Mask (shirolep)
Herbal formulations prepared based on the inner prakriti and taking into consideration the imbalance of doshas helps in strengthening the roots as well as in deep conditioning of the hair shafts.
Kshaurakarma (Hair Cut)
Regular haircuts and keeping hair trimmed helps to protect hair follicles from the stress of being weighed down by the weight of hair strands and prevent split ends.
How Can Telogen Effluvium Be Prevented?
Telogen effluvium can be prevented by keeping the below-mentioned things in mind :
- Consuming adequate amounts of proteins in the daily diet is of utmost importance for better hair growth. Up to 40-60 gms of protein intake per day is recommended. Intake of a good amount of fruits, vegetables, pulses, nuts, and seeds all together helps in minimizing hair loss.
- Intake of supplements for certain hair nutrients such as Vitamin A, E, C, D, zinc, selenium, iron, and Vitamin B12 is necessary since all these nutrients may not be met through a regular diet to meet the daily RDA.
- Effective stress management through meditation, music therapy and deep breathing exercises helps in controlling cortisol levels which interferes with the smooth functioning of hair cycles.
- Getting enough hours of sleep and good quality sleep is important for combating stress as well as rejuvenating the hair follicles.
- Make sure you don't follow fad or crash diets since they can lead to several nutritional deficiencies. Nutritional deficiencies can trigger telogen effluvium hence following a balanced diet under the supervision of a qualified nutritionist can ensure that we are meeting most of the nutrient requirements for better hair growth.
Q1 - How Do I Know If I Have Telogen Effluvium?
When profuse hair shedding of more than 100 strands per day is observed lasting for a period of 4-6 months or more after any significant physiological trigger such as surgery, illness or childbirth, then it is to be identified as you are suffering from telogen effluvium.
Q2 - How Long Does Telogen Effluvium Last?
It depends on how far the trigger factor has been corrected and managed. So it can last as less as 2-3 months or can prolong till 5-6 months or more.
Q3 - What Triggers Telogen Effluvium?
The main triggers for telogen effluvium can be phases of physiological stress such as childbirth, surgery, certain medications, illness, metabolic diseases, and endocrine diseases.
Q4 - Does Hair Loss From Telogen Effluvium Grow Back?
Yes, if the physiological trigger is corrected or managed effectively and the hair cycle of hair follicles is set in the proper pattern, telogen effluvium can be reversed.