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Telogen Effluvium – Interpretation and Management
By Tony Pearce RN.
Specialist Trichologist, National Trichology Services
Body hair has played a key role in the evolutionary success of all warm-blooded creatures that inhabit the Earth. Heat insulation is perhaps the most crucial, but other important functions of hair are the communication of social and sexual maturity – such as a lion’s mane, or the sensory antennae that is the whiskers of cats; as vital camouflage with surroundings, in displays of aggression, or to promote scent dispersal of territorial and mating animals.
Man is the least hairy of the primates but body hair still aids as a thermal regulator; odour dispersion through armpits and groin – and perhaps most significantly over the past centuries – as a fashion and cosmetic adornment of the head.
Hair grows from follicles, which together with sweat and oil glands are appendages of skin tissue. It is estimated that a sexually-mature adult male possesses approximately five million hair follicles on his body; one million on the head and (on average) 100,000 in the scalp (Dawber + Van Neste: 1995). All the hair follicles a person will possess during their lifetime are believed to be in place at the halfway point of a normal pregnancy. And whilst there has been much research into follicle ‘cloning’ – hair follicles cannot be regenerated by adult skin once they are lost.
Scalp follicle hair growth in humans is a continuous cycle which in normal hair growth comprises two main phases:
- Anagen – the growth phase of 2-8 years; 85-90% of all hair is ‘anagen’ in normal circumstances.
- Catagen/Telogen – the resting and shedding phase of the hair cycle are generally combined; ‘catagen’ duration is around 7 days and ‘telogen’ 2-3 months. Only 6-10% of hair is in ‘telogen’ at any given time.
Human hair follicles are NON-synchronised to prevent seasonal moulting, although different parts of the body have varying hair growth depending upon the season of the year (Van Neste + Lachapelle: 1989). Every follicle has an independent hair cycle, and repeats this cycle 10-20 times over a person’s lifetime.
Telogen Effluvium/Defluvium (TE) was the diagnostic term to describe the rapid and excessive shedding of follicle scalp hair following pyrexic illness and fever. TE was also known as ‘Post-febrile Alopecia’.
TE is now held to be a non-specific reaction to a wide variety of physiological and/or emotional stressors that synchronise up to 50% of all scalp hair follicles into a premature termination of ‘anagen’ phase – which then moves into ‘telogen’ shedding phase.
Some common initiators of TE are:
- Acute illness – particularly when accompanied high febrile states (elevated body temperature); vomiting and diarrhoea – especially from contaminated food/water.
Sudden emotional shock or prolonged and unrelenting mental distress.
- Surgical or extensive dental procedures – particularly when substantial blood loss or intra-operative complications have occurred.
- The commencement or cessation of certain medication such as hormonal therapy or anti-convulsant/mood stabilising drugs (Sodium Valproate/Phenytoin Sodium). The administration of intravenous drugs such as antibiotics or chemotherapy or blood dialysis.
- Rapid weight loss in a short period of time either by ‘crash-diet’ or illness. A dramatic change in one’s diet; any ‘fad’ diet that promotes the exclusive or excluded intake of certain major foods groups, or harsh detoxification diets.
- Following childbirth (post partum). Post partum alopecia is considered the one true moult in humans, and results from the intense hormonal changes within a pregnant woman before and after childbirth.
One to four months (average 2-3 months) after any of these experiences, the hair will begin to shed abruptly and be lost in excessive amounts for about 2-3 months before settling.
Whenever a telogen effluvium episode is triggered the shed is diffuse i.e.: hair fall from the entire scalp rather than focal or patchy loss. The rapidly dividing matrix cells of growing hair are very sensitive to nutritional, metabolic/hormonal or environmental disturbances – and often one of the first areas of the body to reflect disturbances in physiological functioning.
Ordinarily TE is considered a ‘temporary & self-correcting’ form of diffuse hair loss.
In certain circumstances an initiating incident may temporarily disrupt ‘anagen’ phasing rather than terminate it. The hair shaft continues to grow, but is fragile where the interruption occurred. As the hair grows beyond its supporting follicle it fractures and breaks off at this weakened point (termed Trichorrhexis nodosa) approximately 4-6 weeks after the initiating incident (Olsen, EA: 1994). Over-processing of hair in perming or bleaching of hair is a common cause of this.
Management:
Whilst TE is generally a self limiting and ultimately self-correcting form of alopecia, hair is shed in massive amounts and the scalp quickly exposed as hair density falls to 50% of what it previously was. The spectre of total hair loss is emotionally devastating to women of any age – particularly a post-partum mother; often sleep deprived and coping with a new baby.
A careful and detailed history should be reviewed by an experienced, qualified Practitioner to establish the nature of the alopecia; that it’s initiating trigger/s and time frame of shedding fall within the parameters of a TE diagnosis.
Reassuring the client that (in time) a full recovery of lost hair density is the expected outcome cannot be over-emphasised. A blood pathology test should be ordered to assess iron studies, (red cell) zinc, Vitamin D, Iodine, B12 etc. All levels need to be in the 50-75th percentile of respective reference ranges to facilitate a more rapid
‘re-setting’ of follicle anagen phasing.
Activance Rhodanide is a natural ‘leave-in’ treatment (the vitaminoid Rhodanide is the active nutrient) which I have found very effective in accelerating TE resolution. Unlike Minoxidil it is completely safe for lactating/breast-feeding women to use (Minoxidil is excreted in breast milk). www.activance.com.au.
Photo-biotherapy such as ‘soft/cold’ low level laser light (LLLT) is in my experience most effective in TE shedding due to its anti-inflammatory and vaso-dilating (blood perfusion) properties. To be therapeutically effective these laser appliances should be classified ‘3A’; be in the red light spectrum + wavelength vicinity of 660-780nm. Bio-available power output should be 60-100mW. Note: some commercially-sold hand held lasers have a power output of 1.5-5mW! Despite their distributor’s claims I believe they offer little more than placebo effect.
Someone experiencing early TE shedding would require TWO 15-20 minute sessions per week for a maximum of six weeks (12 treatments). Twelve treatments should cost no more than a couple of hundred dollars and be undertaken in conjunction with baseline blood testing and any subsequent supplementation required. LLLT is a non-UV light source and considered an adjunct (2nd line additional) treatment.
Continual hair shed over many months is often given the label ‘Chronic Telogen Effluvium’. In my opinion this is a NON-diagnosis – in the same vein as ‘stress’ or ‘irritable bowel syndrome’. The reason/s for hair loss in females is multi-factorial and linked to their nutritional-metabolic and/or hormonal ability to support hair growth. Thinning scalp hair density is often an early warning sign of internal disturbance such as iron deficiency, thyroid dysfunction or developing autoimmune condition (such as Lupus or autoimmune thyroiditis).
The amount of hair shed daily or over a week varies in all of us, and is determined by a number of factors. Therefore the practical definition of excessive hair loss is ‘more than the individual would normally lose’.
© Copyright Anthony Pearce 2009 References for this article available on request.
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