Telogen effluvium is a type of hair loss that anyone can develop. Triggered by physical or psychological stressors, it is quite common.
The problem with this kind of hair loss is that it doesn’t occur right away after a stressful event. In fact, more than a few months pass before telogen effluvium even starts. As a result, when it happens, many people are caught unaware.
The guide will help you understand the potential triggers, signs, reversibility and treatments for this type of hair loss.
What Is Telogen Effluvium?
Telogen effluvium is a type of temporary, non-scarring alopecia that results in diffuse thinning of the hair. Even though it causes shedding across the entire scalp, bitemporal hairs may be affected the most, as noted in the book Hair and Scalp Disorders.
“Telogen” in telogen effluvium refers to the resting phase of the hair growth cycle, whereas “effluvium” refers to the hair falling out in the said stage. Telogen is a normal part of the hair growth cycle, and at any given time, only around 15% of the hair is in this phase.
Designed by Freepik
However, if the cycle is disrupted due to a stressor, it can push around 70% of the hair into the telogen phase. As a result, you can lose 300 hair strands daily — instead of the usual 100 to 150 hairs.
It won’t cause instant shedding because the telogen phase lasts for 3-4 months. The hair stays in the resting stage and is finally shed after that time – which is months following the stressful event.
Interestingly, the shedding of the telogen hair is actually a sign of new hair growth. Old hair is pushed out of the scalp only when there’s new hair growing underneath it. So, even though you’re losing hair, you’re growing new hair simultaneously. The effects of the later will, of course, take a few months to become noticeable.
Telogen effluvium can affect men and women of all ethnicities, regardless of their age. It is, however, more often reported in women, probably because they tend to notice it more and seek medical attention.
What Are The Different Forms Of Telogen Effluvium?
Telogen effluvium is mainly classified into two categories, which are as follows:
Acute Telogen Effluvium
Telogen effluvium is considered acute when it lasts for fewer than 6 months. This kind of hair loss also starts around 3 months after the stressful event (which is not always known). However, it eventually resolves on its own. According to research published in Cureus, acute telogen effluvium goes into remission in 95% of the cases.
(A), Frontal fringe. (B), hair rarefaction on the temporal region and (C), occipital fringe hair regrowth after effluvium post-weight loss. Contin LA, Rocha VB. Acute telogen effluvium triad after resolution. An Bras Dermatol. 2021 Sep-Oct;96(5):605-608. doi: 10.1016/j.abd.2020.10.008. Epub 2021 Jul 14. PMID: 34272075; PMCID: PMC8441517/CC BY 4.0
Chronic Telogen Effluvium
When telogen effluvium lasts for more than 6 months, it’s considered chronic. While it’s not exactly understood why, it most commonly affects women between the ages of 30 and 60.
This kind of telogen effluvium can last for as long as 10 years. And it’s not always continuous; it can come and go away from time to time.
Saki N, Aslani FS, Sepaskhah M, Shafiei M, Alavizadeh S, Hosseini SA, Asl FA, Ahramiyanpour N. Intermittent chronic telogen effluvium with an unusual dermoscopic finding following COVID-19. Clin Case Rep. 2022 Aug 9;10(8):e6228. doi: 10.1002/ccr3.6228. PMID: 35957778; PMCID: PMC9361802/CC BY 4.0
An important thing to note about chronic telogen effluvium is that even though it causes abnormal hair loss, overall hair density appears unaffected. That’s because lost hair is rapidly replaced by new ones.
Can Chronic Telogen Effluvium Be Reversed?
According to research, chronic telogen effluvium is “self-limiting in the long run” and does not result in complete loss of hair. Furthermore, a resolution of the condition has been noted with oral minoxidil.
Therefore, it is possible for your hair loss to reverse even with chronic telogen effluvium. You should, however, consult a medical professional.
What Causes Telogen Effluvium?
Telogen effluvium can be caused by a range of physical, mechanical, chemical and environmental stressors. In fact, the cause can be multifactorial, which makes it difficult to pinpoint the exact cause.
In general, however, telogen effluvium can occur due to any of the following:
- Emotional stress (including anxiety and depression)
- Childbirth
- Major surgery
- Febrile illness (one accompanied by fever)
- Infection
- Inflammation
- Metabolic stress
- Hormonal imbalance
- Autoimmune disease
- COVID-19
- Weight loss
- Crash dieting
- Nutritional deficiency
- Eating disorders
- Toxins
- Hair dyes
- Trauma
Telogen effluvium can also be triggered by certain classes of drugs. Some of the examples are as follows:
- Blood-thinners
- NSAIDs
- Blood pressure medication (beta-blocker, captopril)
- Antithyroid agents (propylthiouracil)
- Stimulants (amphetamines)
- Hormonal drugs (oral contraceptives)
- Anti-seizure medication
- Retinoid (vitamin A)
- Psychiatric medication
Even babies experience a kind of acute telogen effluvium due to hormonal changes following birth.
Can Lack Of Sleep Cause Telogen Effluvium?
A lack of sleep can cause telogen effluvium indirectly, resulting in hair loss.
Lack of sleep can cause stress, hormone imbalance, weakened immunity, and nutritional deficiency, among other things. One of the types of hair loss that you can experience as a result is telogen effluvium.
Types of Telogen Effluvium
Telogen effluvium can have different types depending on the cause. These were defined by the dermatopathologist John T. Headington in his research titled “Telogen Effluvium. New Concepts and Review.” Here’s a summary of them:
- Immediate Anagen Release: It refers to the premature shifting of hair follicles from the anagen to telogen phase. This type of telogen effluvium is believed to occur due to fever or medication.
- Delayed Anagen Release: Also termed telogen gravidarum, it occurs after childbirth due to a drop in the oestrogen levels. It usually occurs 2-3 months after birth. However, sometimes, it’s delayed for 6 months.
- Short Anagen: Due to unknown reasons, the duration of the anagen phase is shortened. As a result, more hair enters the telogen phase, which causes abnormal shedding. It results in chronic effluvium.
- Immediate Telogen Release: It results in the shortening of the telogen phase, which results in the release of club hair after 4-6 weeks. It happens with the use of minoxidil.
- Delayed Telogen Release: It’s when the hair is retained in the telogen phase for a longer period (than usual). However, once that ends, abnormal shedding results. This happens in case of seasonal hair loss.
Essentially, telogen effluvium results from an abnormality in the hair growth cycle. And that can occur due to many factors.
What Is The Difference Between Telogen And Anagen Effluvium?
Anagen effluvium occurs when the anagen (growth) phase of the hair growth cycle is abnormally interrupted. Most commonly, it occurs due to chemotherapy.
On the other hand, telogen effluvium occurs due to an abnormal shift of the majority of the hair from the anagen phase to the resting telogen phase. This type of hair loss can occur due to a number of physical and emotional stressors.
Is Telogen Effluvium Common?
It’s not exactly known how prevalent telogen effluvium is, but it’s considered a “common” type of hair loss. Research shows that it’s the most common cause of diffuse hair loss.
Many of telogen effluvium’s triggers are not always avoidable. So, there’s a good chance that you’ll develop it at some point in your life. Therefore, it’s quite common, maybe even more so in women.
How Do You Know If You Have Telogen Effluvium?
Telogen effluvium is characterised by abnormal diffuse shedding. Many people notice more hair on their pillows, in the hairbrush, drain or, in general, around the house.
It can happen quite suddenly as well, so that’s another indicator. And while it can cause overall thinning, it’s unlikely to cause baldness.
You can consider taking a look at the bulb of the hair. If it’s club hair, the colour of the root will be lighter than the rest of the hair.
In some cases, trichodynia – a painful, itching and burning sensation of the scalp, also accompanies telogen effluvium. So, that may be another indicator of this type of hair loss (it also happens in androgenetic alopecia).
DermNet reports another possible sign of telogen effluvium – a Beau line. It refers to a horizontal indentation or groove in the fingernails that can develop due to stress. The position of the line can show when the stressful event actually took place.
Other than affecting the scalp, including the front and the crown areas, telogen effluvium can also occur in the eyebrows as well as the pubic area.
Does Telogen Effluvium Cause Hair Miniaturization?
Several researches have reported the absence of hair miniaturization in telogen effluvium. This means that contrary to androgenetic alopecia, hair follicles do not shrink, and hair does not thin in telogen effluvium.
How Long Does Telogen Effluvium Last?
Telogen effluvium usually lasts for 3-6 months (unless it’s chronic). As hair falls out, new hair will grow underneath. So, regrowth will also start after 3-6 months.
It can, however, take 1-1.5 years for your hair to completely recover.
Keep in mind that telogen effluvium won’t stop unless the underlying problem has been resolved.
While it’s not always known, this type of hair loss usually resolves on its own. And since it’s reversible, your hair will start to grow again.
Can You Go Bald From Telogen Effluvium?
Telogen effluvium typically does not result in complete or even visible baldness. This is even true for those who experience chronic telogen effluvium.
What Does Telogen Effluvium Regrowth Look Like?
After telogen effluvium has stopped, you’ll eventually start to notice the growth of short, fine, fringe hair.
One study published in the Anais Brasileiros de Dermatologia proposed that hair grows in a triad (front, temples and back of the head) following the resolution of telogen effluvium. The researchers noted the growth of fine hair fringes in all these areas.
Contin LA, Rocha VB. Acute telogen effluvium triad after resolution. An Bras Dermatol. 2021 Sep-Oct;96(5):605-608. doi: 10.1016/j.abd.2020.10.008. Epub 2021 Jul 14. PMID: 34272075; PMCID: PMC8441517/CC BY 4.0
How To Fix Telogen Effluvium?
Since telogen effluvium is self-limiting, it usually doesn’t require any treatment. Nevertheless, you should seek medical attention. That’s because telogen effluvium may be triggered by an underlying health problem. And if it’s not treated, your hair loss will continue.
For instance, thyroid disorders can cause chronic telogen effluvium. Similarly, nutritional deficiencies can cause telogen effluvium. And hair loss will continue unless the problem is addressed through necessary changes to the diet.
However, if the problem is likely to fix itself, like hormonal changes after pregnancy, you might not need to do anything for the telogen effluvium to resolve.
While no treatment might be needed, your doctor might recommend the use of minoxidil to stimulate hair growth. This drug works by dilating blood vessels to deliver more nutrients to the hair follicles. Although minoxidil is usually reserved for chronic telogen effluvium.
You might also be recommended platelet-rich plasma injections for promoting regrowth.
A surgical intervention like hair transplant is not really required because telogen effluvium is reversible.
While you’re experiencing telogen effluvium, it’s important that you practise gentle hair care. For instance, you should avoid excessive use of heat-styling tools.
You should also consider using products that don’t have as many “harsh” chemicals in them.
Does Finasteride Help With Telogen Effluvium?
Finasteride is unlikely to help with hair loss due to telogen effluvium.
This drug is more commonly used in the treatment of male androgenetic alopecia, where it blocks an enzyme (5-alpha reductase) from converting testosterone into its more potent form, dihydrotestosterone.
Androgenetic alopecia is caused by different factors from telogen effluvium, and though finasteride is effective for the former, the same cannot be said for the latter.
Can Telogen Effluvium Be Cured?
Telogen effluvium is usually self-correcting and completely reversible on its own. Therefore, it doesn’t require any “cure.”
Still, keep in mind that you shouldn’t avoid a medical consultation. That’s because hair loss might be fuelled by a health problem.
How To Prevent Telogen Effluvium?
Telogen effluvium can be caused by a combination of internal and external factors, so it’s not always possible to prevent it.
In some instances, you can, however, avoid it. For example, if you have stress hair loss due to telogen effluvium, you should consider seeking professional help to manage it.
But, again, it’s not always possible.
How To Diagnose Telogen Effluvium?
Other than asking about your history, your doctor will perform a physical exam to check for signs of telogen effluvium. They may do a dermoscopy or videodermatoscopy for that.
This can also be accompanied by some diagnostic tests, such as the:
- Hair pull test
- Hair wash test
- Hair pluck test (trichogram)
CBC and thyrotropin tests might also be done to determine the root cause of the problem.
Scalp biopsy is not usually needed, but it is done in some cases.
How To Hide Telogen Effluvium?
While you’re recovering and regrowing your hair, you can hide telogen effluvium through the following:
- Wigs
- Toppers
- Hair fibres
- New haircut/hairstyle
- Volumising products
- Scarves, hats, and caps
These measures may help you cope better with hair loss due to telogen effluvium.
Experiencing Hair Loss?
Longevita is an award-winning facilitator of surgical and non-surgical cosmetic treatments, including but not limited to those for hair loss. We arrange access to teams of highly experienced professionals and are proud to have helped thousands from around the globe. If you’re interested in learning more about our services, get in touch!
Frequently Asked Questions
It’s possible for you to experience telogen effluvium more than once. That’s because it can be triggered by many factors.
While chronic telogen effluvium can last for as long as a decade, it has the potential to stop. It might be occurring due to an underlying problem, which is why you must seek professional help.
A particular hair loss shampoo is unlikely to help you with telogen effluvium. However, it’s important to use a mild one so that it doesn’t cause further damage to your hair.
Telogen effluvium affects the front and temporal areas on the scalp more, so it can cause thinning, however, it won’t necessarily cause a recession in your hairline.
Unless a vitamin deficiency is causing telogen effluvium, vitamins or supplements aren’t going to help you.
In more severe cases, telogen effluvium can affect the scalp, facial and body hair.
According to DermNet, new hair will continue to grow even during telogen effluvium. As telogen hair is shedding, new hair is growing underneath.
According to the American Osteopathic College of Dermatology, hair loss in telogen effluvium comes to a gradual halt. Hair loss usually decreases in a period of more than 6-8 months after the underlying cause has been dealt with.
Where telogen effluvium hair loss is typically diffuse, androgenetic alopecia progresses in a distinct pattern in males. Additionally, one of the notable features of pattern baldness is that it results in the miniaturization and thinning of the hair. This cannot be seen happening in telogen effluvium. For an accurate diagnosis, however, you must get in touch with a medical professional.
Dr Cagla
Dr Cagla earned her medical degree at Trakya University’s Faculty of Medicine in Bulgaria and has almost 6 years of hair transplantation experience. She is a specialist in FUE, DHI and Sapphire hair transplants of the scalp, eyebrows and beard and has performed over 6,000 surgeries. Dr Cagla is multilingual, with fluency in English, Bulgarian and Turkish.
