Scientific Area

Hair loss (telogen effluvium)

CATEGORIES SCIENTIFIC AREA

Scientific collaboration between Professor Marco Toscani and Dr. Pasquale Fino, Chair of Plastic, Reconstructive and Aesthetic Surgery, Umberto I Health Center – “Sapienza” University of Rome.

Cuoio capelluto: a cosa serve

The term Telogen Effluvium was introduced for the first time by Kligman (*) in 1961 to introduce an acute hair loss of benign origin that follows an intense and short period of stress of different types. Subsequently, Rebora (**) introduced the concept of chronic Telogen Effluvium.

There are two types of Telogen Effluvium: acute and chronic.
In the acute type, the hair loss is sudden and quite intense, following a period of stress that may be brief and very extreme (causes may be: car accidents, death in the family, surgery, high fever, difficult labor), which, by blocking cellular mitosis in the matrix, brings hair from the anagen to the telogen phase.
The phenomenon usually lasts 2 to 3 months (the time necessary for hair that has “taken shelter’ in the telogen phase to fall out) and usually resolves itself spontaneously with the “return” of the fallen hair to the anagen phase.

Tipologie di Telogen Effluvium: acuto o cronico

In the chronic type, the stressful cause is much less clear (causes may be: adaptation problems, states of anxiety, chronic use of some drugs, inadequate diets, debilitating chronic diseases) and tends leads to a high loss of hair that may last months or years, without any seasonal change or spontaneous remission. In this event, in time it leads to widespread hypotrichosis with varying degrees of severity.

The distinction between Telogen Effluvium and alopecia areata (spot baldness), though quite clear on a clinical level, is instead much more difficult and unclear on a nosological level, even if in the former the hair falls out in the telogen phase and in the latter in the dystrophic anagen phase.
Therefore, Telogen Effluvium or Effluvium is a phenomenon characterized by excessive hair loss (hundreds or sometimes thousands) in the telogen phase. Telogen Effluvium as described by Kligman (*) is an acute event that follows an important episode from an emotional point of view. Patients with Telogen Effluvium often complain about a sense of pain, itchiness and stinging on the scalp.
The cause of this sensation has not yet been explained (many attribute it with a neurotic or psychological nature). The structure of these hairs seen under an electronic microscope is similar to that of normal (terminal) hair, with “mature” hair in the telogen phase and without elements of involution (there is no vellus hair).
Almost always the cause of acute Telogen Effluvium is a stressful, very intense but brief, event that affects hair in the anagen subphase 6, leading them to stop in the telogen phase.
This phenomenon may involve a lot of hair (up to 85%, so all anagen 6 hair), causing a widespread loss that starts after 12-15 weeks to continue for around 3 months (that is, the duration of the telogen phase). In the end the hair loss stops naturally and spontaneously, thereby leading to hair regrowth.
During the effluvium phase the relationship between hair in the anagen phase and hair in the telogen phase (shown by the trichogram) changes a lot: At least 25% and up to 85% of hair is found in the telogen phase in this period. The number of fallen hair (called a Wash test) reaches 600 – 1000 hairs, or even more. By running your fingers through the patient’s hair and pulling delicately (called a Pull test) the hair that remains caught between the fingers can sometimes number in the hundreds. Blood tests are not very useful in the majority of cases. If this Effluvium phase occurs in the post-infective forms, blood chemistry tests show an increase in the number of lymphocytes greater than 33% with a maximum number of 4500 lymphocytes/ml. In time, hypotrichosis may occur, which may be more or less accentuated.

The only effective treatment of acute Telogen Effluvium is to stay away from the cause or causes that caused it. It is very important for the doctor to prescribe the depressed and worried patient a treatment to reassure him/her, show that he is interested and ensure the necessary amount of time passes so that the Effluvium phase passes naturally.
Among the drugs prescribed, corticosteroids work well. In the minor forms, a non-halogenated cortisone cream to be applied locally is prescribed (like for example, hydrocortisone butyrate). Instead, in the more serious forms, an intramuscular injection of 40 mg of methylprednisolone is usually prescribed every 7 – 10 days for around 3 cycles. Almost always results are seen quickly, leading to an effective block of the effluvium and a quick return to the anagen phase by the follicles.

Among the most frequent causes of Chronic Effluvium we note: labor and breast-feeding, collagen diseases, acute physical or psychological stress, poisoning, endocrine disorders, fevers, grief, surgery and blood loss, chronic infectious diseases, deficiencies, neurotic or depressing situations, the chronic use or abuse of drugs and anorexia. In many patients with Telogen Effluvium, we may find leukopenia (an antinuclear antibody test is necessary), autoimmune collagen diseases or systemic lupus erythematosus. Especially in women with Telogen Effluvium, we can find iron-deficiency anemia and a lack of other trace minerals (in particular magnesium and zinc), which are very important to hair physiology. The reduction or lack of minerals and electrolytes (such as iron, magnesium, zinc, calcium, sodium and potassium) must be analyzed and if necessary corrected and integrated.

Among the most frequent causes of chronic Telogen Effluvium we can note: frequent blood donations, serious physical illnesses, chronic systemic diseases (infectious, metabolic or neoplastic diseases), dysthyroidism and chronic drug use (retinoids, interferon, allopurinol, anticonvulsants, antithyroid drugs, beta blockers, heparin, lithium, warfarin, vitamin A and some oral contraceptives). In some cases surgery or hair transplant leads to telogen effluvium due to surgical stress which results in temporary hair loss also in the areas not treated surgically, an occurrence that creates a notable state of anxiety in patients, hair regrowth occurs in the majority of cases in a period varying from three to twelve months.

Bibliographical references:
(*) Kligman A.M., Why do nails grow out instead of up?, Arch Dermatol., 1961 Aug; 84:313-15.
(**) Rebora A., Telogen effluvium: an etiopathogenetic theory., Int J Dermatol., 1993 May; 32(5):339-340.

Dandruff or pityriasis

Dandruff is a scalp condition that usually arises between the ages of 10 and 25. It may improve between the ages of 45 and 55 or may continue during old age.
Its cause is a result of an accelerated turnover of epidermal cells, which following an increase in migration speed, are unable to reach complete maturity before detaching. Whitish-yellow flakes (masses of corneum cells) form and detach, gathering in patches or often spreading evenly across the scalp.

Read more »

Hair loss: manifestation, causes and prevention

A shedding of hair is considered physiologically normal when hair loss is limited to around one hundred hairs per day. During an individual’s life hair grows, falls out and regrows around twenty times. Each cycle, especially for females, may last up to six years and if hair loss is found within this time frame, it is considered absolutely physiological.

Read more »

Structure and chemical composition of hair

The hair on our bodies has a particular structure and is divided into thin and thick hair. Thin hair, also called lanugo or vellus, is located on all skin surfaces except for the palms of the hands and the soles of the feet. Thick hair, also called terminal hair, is dark and located only in some areas such as the scalp, the armpits, the pubic area, the beard area in the case of men, etc…

Read more »

Hair loss from trichotillomania

Trichotillomania is a type of hair loss due to voluntary pulling by the patient which often ends up breaking the hair shaft. In general, the patient twists the hair around a finger.
The gesture is occasional when going to sleep or concentrating on a task, but may become repetitive or obsessive.

Read more »

Seborrheic dermatitis

Seborrheic dermatitis is a very common scalp condition characterized by the presence of yellow and oily flakes on the skin.

It is associated with erythema, small scaly, and intense itching.
Seborrheic dermatitis is a well-known condition but is still not easily identifiable. Many men and women starting from puberty have oily, greasy, shiny and thickened skin with large hair follicles, especially noticeable around the nose and mouth, forehead, torso, scalp (affected by so-called oily dandruff).

Read more »

FIND YOUR NEAREST CENTER

Let our experts find the best solution for you.

BOOK A CONSULTATION

Book a consultation with our experts. Find out more about CRLAB solutions.

BOOK A VIDEO CONSULTATION

Let our experts find the best solution for you.

Hair loss solutions for you. CRLAB, specialists in the well-being of your hair and scalp.

1.Trichology scalp and hair care

To put the health back into your hair, you first need to nourish your scalp. Our trichology treatments care for your scalp and hair, using cutting-edge technologies with a full range of laboratory-tested products. All made with high quality raw materials.

2. CRLAB hair prosthetic system

The ultimate answer to your hair loss. Rediscover yourself, with naturally thick hair. A patented solution that integrates real hair into areas where you’re experiencing thinning or hair loss. A fully customized hair enhancement that will look totally natural on you. Plus, it’s so functional, it gives you the freedom to live your life the way you want to.

3. Hair transplant surgery

We work with the top hair transplant professionals, to find the best transplant method for you.