Domaine scientifique

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.

Grey hair

In the trichological field, with the passing of age hair whitening is seen to follow the greying process of the hair on the scalp (called grey hair). Hair becomes grey (white) following a natural biological aging process of the melanocytes, which are the cells tasked with coloring hair.
In the majority of people, the first grey hairs appear around 35/40 years of age in women and around 30/35 in men.

Lire la suite »

Dry hair

Both men and women of any age may have dry hair. This situation is endured not only as an aesthetic problem, but in time may represent a problem concerning hair health. Dry hair often appears weak, fragile and tends to become brittle and to break.
Dry hair often has split ends and other forms of damage to the shaft.

Lire la suite »

Chute des cheveux : manifestation, causes et prévention

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.

Lire la suite »

Chute de cheveux par trichotillomanie

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.

Lire la suite »

Brittle hair

Brittle hair is hair that appears opaque and without shininess. It is characterized by glaringly visible damage and deterioration of the shaft.
The causes that lead to the problem of brittle hair may be of endogenous and exogenous origin.

Lire la suite »

TROUVEZ VOTRE CENTRE LE PLUS PROCHE

Laissez nos experts trouver la meilleure solution pour vous.

RÉSERVER UNE CONSULTATION

Réservez une consultation avec nos experts. En savoir plus sur les solutions CRLAB.

RÉSERVER UNE CONSULTATION VIDÉO

Laissez nos experts trouver la meilleure solution pour vous.

Nos solutions autour de la perte de cheveux

La Trichologie

Les bienfaits de nos traitements trichologiques sont cliniquement prouvés. Ces soins capillaires nourrissant et rééquilibrant permettent de retrouver un cuir chevelu sain et des cheveux plus forts et beaux.

La Prothèse Capillaire

Notre dispositif médical, certifié, breveté, et réalisé sur mesure en Italie, est une solution qui intègre de vrais cheveux dans les zones où vous souffrez d’amincissement ou de pertede cheveux.

La Greffe de Cheveux

Nous travaillons avec les meilleurs professionnels pour trouver les implants capillaires qu’il vous faut.