Telogen effluvium is excessive loss of normal club hairs which occurs when anagen follicles change to the telogen phase too fast and too soon. In healthy adult, but young, subjects, about 80% of the follicles are in anagen.
The only clinical manifestation of this condition is that the patient notices that large numbers of hairs (100—1,000) come out every day when he combs his hair or washes it. Alopecia need not be clinically pronounced if the hair is normally thick and the effluvium does not last very long. Accessory effluvium in cases of male pattern alopecia which had previously been inconspicuous makes them more noticeable. Rapid or prolonged effluvium gives rise to marked diffuse alopecia, which may be severe, but never total. If the cause is abolished, or is not repeated, the hair almost always grows again spontaneously within half a year. Prolonged fever, as in typhoid, or a difficult labour, may result in permanent destruction of some of the follicles.
Telogen effluvium is caused by various types of stress, such as fever, protracted and difficult labour, surgical operations, haemorrhage, the donation of blood, enforced severe starvation or a sudden one sided diet or mental stress. The number of follicles affected and the degree of effluvium depend on the duration and intensity of the stress and also, of course, on the individual susceptibility of the hair follicles. Club hairs may remain in the skin for about 3 months, until the affected follicles have passed completely into a new anagen phase, or they may fall out prematurely. In late pregnancy, a normal change to catagen is prevented by factors which after labour probably cease to take effect, and the hair comes out diffusely on either a conspicuous or only a subclinical scale. Discontinuation of the long term use of hormonal contraceptives can have similar consequences.
Histologically, the number of follicles in telogen is only relatively elevated and the hairs which come out have the normal club shape. The main diagnostic criterion of telogen effluvium is loss of hair 6—16 weeks after a stress situation and the presence of an excessively large number of normal club hairs in the trichogram. Acute alopecia areata is at first generally focal, although it can change quickly to total. Telogen effluvium, however, is always diffuse and the alopecia is never total. Acute syphilitic alopecia is more of a minifocal (areolar) type and other manifestations of the disease are found as well. Increased loss of club hairs can also be a variable, but often striking, manifestation of androgenic alopecia. Chemical alopecia (e.g. after heparin) can have a similar time course to telogen effluvium, but the trichogram is sometimes different.
Normal stimulant" — preferably specific psychotherapeutic — methods are sufficient for treatment, since anagen hairs usually grow again spontaneously.
The only clinical manifestation of this condition is that the patient notices that large numbers of hairs (100—1,000) come out every day when he combs his hair or washes it. Alopecia need not be clinically pronounced if the hair is normally thick and the effluvium does not last very long. Accessory effluvium in cases of male pattern alopecia which had previously been inconspicuous makes them more noticeable. Rapid or prolonged effluvium gives rise to marked diffuse alopecia, which may be severe, but never total. If the cause is abolished, or is not repeated, the hair almost always grows again spontaneously within half a year. Prolonged fever, as in typhoid, or a difficult labour, may result in permanent destruction of some of the follicles.
Telogen effluvium is caused by various types of stress, such as fever, protracted and difficult labour, surgical operations, haemorrhage, the donation of blood, enforced severe starvation or a sudden one sided diet or mental stress. The number of follicles affected and the degree of effluvium depend on the duration and intensity of the stress and also, of course, on the individual susceptibility of the hair follicles. Club hairs may remain in the skin for about 3 months, until the affected follicles have passed completely into a new anagen phase, or they may fall out prematurely. In late pregnancy, a normal change to catagen is prevented by factors which after labour probably cease to take effect, and the hair comes out diffusely on either a conspicuous or only a subclinical scale. Discontinuation of the long term use of hormonal contraceptives can have similar consequences.
Histologically, the number of follicles in telogen is only relatively elevated and the hairs which come out have the normal club shape. The main diagnostic criterion of telogen effluvium is loss of hair 6—16 weeks after a stress situation and the presence of an excessively large number of normal club hairs in the trichogram. Acute alopecia areata is at first generally focal, although it can change quickly to total. Telogen effluvium, however, is always diffuse and the alopecia is never total. Acute syphilitic alopecia is more of a minifocal (areolar) type and other manifestations of the disease are found as well. Increased loss of club hairs can also be a variable, but often striking, manifestation of androgenic alopecia. Chemical alopecia (e.g. after heparin) can have a similar time course to telogen effluvium, but the trichogram is sometimes different.
Normal stimulant" — preferably specific psychotherapeutic — methods are sufficient for treatment, since anagen hairs usually grow again spontaneously.
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