Telogen Effluvium

Classify the presentation as acute when diffuse shedding has lasted less than 6 months and chronic when it persists beyond 6 months. Acute telogen effluvium typically begins 2-3 months after a trigger, although diffuse shedding may present 1-6 months after a precipitating event. High-yield exposures include febrile or severe systemic illness, major surgery, childbirth, pregnancy-related events, weight loss or caloric restriction, emotional or physiologic stress, thyroid disease, medications, and nutritional disturbance. ScienceDirect+3ScienceDirectAlopecia in general medicine - ScienceDirect.comWileyChronic diffuse alopecia in women: a retrospective review of ...Wolters KluwerRole of ferritin, vitamin D, and thyroid... : Al-Azhar Assiut Medical JournalPubMedTelogen Effluvium: A Review of the Literature - PMC

A history of more than 100 shed hairs daily or collection of 100 or more hairs over 24 hours supports excessive shedding, but neither measure establishes etiology. Ask specifically about timing of infection, hospitalization, surgery, postpartum hemorrhage, restrictive diets, rapid weight loss, and all prescription, over-the-counter, and hormonal drugs; anticoagulants, anticonvulsants, and high-dose contraceptives are among reported medication associations. PubMed+1PubMedTelogen Effluvium - StatPearls - NCBI BookshelfPubMedThe Diagnostic Value of Serum Ferritin for Telogen Effluvium: A Cross-Sectional Comparative Study - PMC

The working diagnosis should remain provisional when thinning is patterned, progression is gradual rather than abruptly shedding-predominant, or there is a strong family history of androgenetic alopecia. Androgenetic alopecia is the most common competing diagnosis in diffuse loss and may coexist with telogen effluvium; trichoscopy can help distinguish these entities. ScienceDirect+1ScienceDirectTelogen Effluvium – a review of the science and current obstaclesScienceDirectDengue-associated telogen effluvium: A report of 14 patients

Obtain testing when the history or examination identifies a plausible reversible branch: thyroid disease, blood loss or inadequate iron intake, restrictive dieting or malnutrition, renal or liver disease, or other systemic illness. Thyroid disease, severe iron deficiency anemia, zinc deficiency, and severe protein, fatty-acid, or caloric restriction are recognized causes of diffuse telogen hair loss. Wolters Kluwer+1Wolters KluwerRole of ferritin, vitamin D, and thyroid... : Al-Azhar Assiut Medical JournalWolters KluwerAn Analytical Study of Serum Ferritin, Vitamin D, and Thyroid ...

Serum ferritin can document iron deficiency, but ferritin is not a stand-alone diagnostic test for telogen effluvium. In one comparative study, mean ferritin in telogen effluvium was 24.27 ng/mL and an optimal discriminating cutoff was 24.45 ng/mL; this finding does not establish a universal treatment target. Proposed ferritin thresholds for hair-loss prevention vary, with >40 micrograms/L used in one study and >15 micrograms/L considered sufficient by some authors. Wolters Kluwer+1Wolters KluwerChronic telogen effluvium in women : Journal of the Egyptian Women's Dermatologic SocietyPubMedThe Diagnostic Value of Serum Ferritin for Telogen Effluvium: A Cross-Sectional Comparative Study - PMC

Order ferritin to evaluate suspected iron deficiency rather than treating a marginal value as proof of causation. Evidence linking iron deficiency without anemia to chronic diffuse loss remains controversial; supplementation is most defensible for documented deficiency or a clinical iron-deficiency syndrome rather than indefinite empiric use. JAMA+1JAMANutritional Supplements and Hair Loss—Limitations ... - JAMA NetworkWolters KluwerAn Analytical Study of Serum Ferritin, Vitamin D, and Thyroid ...

A medication review is a diagnostic intervention. When a drug is temporally plausible, weigh substitution or discontinuation against the risk of interrupting essential therapy; do not stop anticoagulants, anticonvulsants, or hormonal agents solely on the basis of shedding without coordinating with the prescribing clinician. Suspected causative drugs should be replaced or discontinued when feasible. PubMed+1PubMedTelogen Effluvium: A Review of the LiteraturePubMedThe Diagnostic Value of Serum Ferritin for Telogen Effluvium: A Cross-Sectional Comparative Study - PMC

Reserve scalp biopsy for diffuse shedding that lasts longer than 6 months, a discordant history and examination, or persistent uncertainty between chronic telogen effluvium, androgenetic alopecia, and diffuse alopecia areata. Multiple biopsies improve diagnostic accuracy. A biopsy may be necessary because chronic telogen effluvium can overlap clinically with androgenetic alopecia and because diffuse alopecia areata may require exclusion. ScienceDirect+1ScienceDirectCHRONIC TELOGEN EFFLUVIUM - ScienceDirectPubMedTelogen Effluvium: A Review of the Literature

On scalp biopsy, chronic telogen effluvium shows increased telogen hairs; one review reports an anagen:telogen ratio of approximately 8:1 compared with 14:1 in normal scalp. In a large chronic telogen effluvium series using 4-mm horizontal sections, the mean terminal-to-velluslike ratio was 9:1, with 89% terminal hairs in anagen and 11% in telogen. ScienceDirect+1ScienceDirectChronic telogen effluvium: Increased scalp hair shedding in middle-aged women - ScienceDirectPubMedTelogen Effluvium: A Review of the Literature

Follicular miniaturization argues against isolated telogen effluvium and favors androgenetic alopecia. Peribulbar infiltrate also is not expected in uncomplicated telogen effluvium. In the comparative histology series, significant inflammation and fibrosis occurred in 37% of androgenetic alopecia cases versus 10%-12% of chronic telogen effluvium cases and controls. ScienceDirect+1ScienceDirectChronic telogen effluvium: Increased scalp hair shedding in middle-aged women - ScienceDirectPubMedTelogen Effluvium: A Review of the Literature

For acute telogen effluvium, correct the identified precipitant: treat thyroid disease or other systemic illness, address documented iron or nutritional deficiency, stop or substitute a likely causative medication when clinically safe, and treat concurrent scalp psoriasis or seborrheic dermatitis. If no trigger is found, explain that a cause remains unidentified in approximately one-third of acute cases and schedule reassessment rather than assigning a permanent diagnosis prematurely. PubMed+1PubMedTelogen Effluvium: A Review of the Literature - PMCPubMedTelogen Effluvium: A Review of the Literature

Counsel that acute telogen effluvium is usually self-limited. About 95% of acute cases remit in one review, and most patients regain normal fullness within 6-9 months; restoration of baseline thickness can take up to 18 months. Short regrowing frontal hairs on follow-up support recovery. Wolters Kluwer+1Wolters KluwerCovid Induced Telogen Effluvium (CITE) : Indian Dermatology Online JournalPubMedTelogen Effluvium: A Review of the Literature - PMC

Topical minoxidil has theoretical effects on the hair cycle but has not been proven to promote recovery in telogen effluvium. It may be discussed only as an individualized adjunct, particularly when coexisting androgenetic alopecia is suspected, while explicitly distinguishing this from evidence-based trigger correction. Wolters Kluwer+1Wolters KluwerCovid Induced Telogen Effluvium (CITE) : Indian Dermatology Online JournalPubMedTelogen Effluvium - StatPearls - NCBI Bookshelf

Avoid empiric long-term nutritional supplementation in the absence of a severe or documented deficiency. Nutritional supplements are described as appropriate for severe deficiency and not recommended for long-term routine use; ferritin, zinc, and vitamin D abnormalities may be common in populations with and without chronic telogen effluvium. JAMA+1JAMANutritional Supplements and Hair Loss—Limitations ... - JAMA NetworkWolters KluwerChronic telogen effluvium in women : Journal of the Egyptian Women's Dermatologic Society