Telogen Effluvium

Introduction to TE - Sudden Shed Show

Telogen Effluvium (TE) is diffuse, non-scarring hair shedding. Stressors prematurely shift hairs from the growth to the resting phase.

• Normal Hair Cycle Phases: 📌 All Cats Talk
  • Anagen (Growth): 85-90% of hairs; lasts 2-6 years.
  • Catagen (Transition): <1% of hairs; lasts 2-3 weeks.
  • Telogen (Resting): 10-15% of hairs; lasts 2-3 months, then sheds.
• TE Disruption: ↑ Hairs prematurely enter telogen. Shedding typically follows 2-4 months after a trigger.

⭐ Normally, 10-15% of scalp hairs are in the telogen phase. In TE, this can increase to >30%, sometimes up to 50%.

TE Etiology - Trigger Happy Hair

Onset typically 2-4 months post-trigger.

Common Triggers:

• Physiological stress: Surgery, high fever (e.g., COVID-19, typhoid), severe illness.
• Psychological stress: Major life events.
• Postpartum period.
• Nutritional deficiencies: ↓Iron, ↓zinc, ↓biotin, ↓protein.
• Endocrinopathies: Thyroid disorders (hypo- or hyperthyroidism).
• Medications: Beta-blockers, anticoagulants, retinoids, lithium, OCP discontinuation.
• Crash diets / Rapid weight loss.

📌 TELOGEN Mnemonic for Triggers:

• Thyroid disorders
• Emotional/Psychological stress
• Low iron/nutrition (Fe, Zn, Biotin, Protein)
• Obstetrical (Postpartum)
• Germs (Severe illness/fever)
• Endocrine (other than thyroid)
• New medications / Nutritional crash

⭐ Postpartum hair loss is a classic, self-limiting form of telogen effluvium, usually resolving within 6-9 months postpartum without specific treatment beyond reassurance and nutritional support if needed (e.g., iron supplementation for deficiency).

TE Clinical & Diagnosis - Spotting the Shed

• Presentation: Acute, diffuse, non-scarring hair shedding. Onset typically 2-4 months post-trigger.
• History: Key to identify trigger (e.g., illness, stress, medication, nutritional deficiency).
• Hair Pull Test:
  • Gently tug ~40-60 hairs.
  • Positive: >10% of hairs (or >4-6 hairs) easily extracted. Hairs show club-shaped roots.
• Scalp Exam: Usually normal; no significant inflammation, scaling, or scarring.
• Trichoscopy Findings:
  • Increased telogen (club) hairs.
  • Empty follicular openings.
  • Upright regrowing hairs (short, tapered).

⭐ Telogen hairs are characterized by a club-shaped root without a gelatinous sheath.

TE Differentials & Management - Ruling Out & Reassurance

• Key Differentials:
  • Vs. AGA & AA:

    Feature	TE	AGA	AA
    Shedding	Acute, diffuse	Gradual, patterned	Sudden, patchy
    Signs	+ve Pull test	Miniaturization	Exclamation hairs

  • Others: Chronic TE (CTE), Anagen Effluvium.
• Management:
  • Reassure (self-limiting). Identify & correct triggers.
  • Nutritional support (if deficient).
  • Topical minoxidil (may shorten telogen; controversial for acute TE).
• Prognosis: Good; recovery 6-12 months post-trigger removal.

⭐ Unlike androgenetic alopecia, telogen effluvium does not typically cause miniaturization of hair follicles or a receding hairline.

High‑Yield Points - ⚡ Biggest Takeaways

• Diffuse, non-scarring hair shedding occurring 2-4 months after a stressful trigger.
• Triggers include childbirth, high fever, surgery, severe emotional stress, crash diets.
• Mechanism: Premature shift of anagen hairs to telogen phase.
• Positive hair pull test (gentle pull yields >4-6 hairs).
• Biopsy shows ↑ telogen hairs (>20-25%); no significant inflammation.
• Typically self-resolving within 6-12 months once trigger is addressed.
• If shedding persists >6 months, consider Chronic Telogen Effluvium.