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Telogen effluvium

Telogen effluvium (TE), first described in 1961 by Klingman, in fact encompasses a wide spectrum of clinical situations where a generalized hair loss in the telogen (rest) phase is observed. Acute and chronic telogen effluvium (CTE) have been identified.

Symptoms
In case of acute telogen effluvium, hair loss is observed on all of the scalp, although patients mostly notice balding in the frontal area. The disease starts abruptly. Telogen effluvium may be triggered by an intrinsic or extrinsic factor which causes a vast number of hair to enter the telogen phase. The aforementioned TE-inducing factors include: diseases with high fever, surgical treatments, psychological stress, pregnancy, thyroid function disorders, end of estrogen therapy, unbalanced low-calorie diets (strict diets), iron deficiency, drugs (beta blockers, anticoagulants, retinoids, carbamazepine, vaccines), scalp diseases (psoriasis, seborrheic dermatitis of the scalp) and exposure to ultraviolet light. Telogen effluvium may be chronic and is considered to be a separate disease entity. A chronic TE may be primary or occur as a secondary condition, accompanying such general disorders as malnutrition, renal or liver failure, systemic lupus erythematosus or HIV infection. Clinically, chronic TE is manifested by a diffuse telogen hair loss afflicting the entire scalp and lasting longer than 6-8 months.

Course of disease
In case of acute telogen effluvium, a sudden diffuse, and sometimes massive hair loss, is observed, followed by spontaneous hair regrowth within 4 to 6 months. In many cases, the improvement is spontaneous. No complete hair loss is observed. In case of chronic telogen effluvium, hair loss persists for more than 6-8 months. In anamnesis, patients often mention many years of losing hair with periods of increased intensity and remissions. Sometimes hair loss is accompanied by thinning of hair shafts, affecting all areas of the head and subjective symptoms, like hypersensitivity or tenderness of scalp. No complete baldness is observed in CTE.

Diagnosis
The diagnosis is based on a detailed anamnesis and analysis of the clinical picture. Apart from a trichoscopy evaluation, a trichogram is helpful.

Treatment
TE therapy is aimed at the elimination of triggering factors: endocrinopathy, metabolic disorders, deficiencies and TE-inducing drugs. Corticosteroids are used externally in TE treatment.