Telogen Effluvium: A Review of the Literature

Abstract

Telogen effluvium is one of the most common causes of alopecia. It is a scalp disorder characterized by excessive shedding of hair. Several factors such as drugs, trauma, and emotional and physiological stress can lead to the development of telogen effluvium. Multiple alterations in the hair cycle have been proposed as the underlying mechanism. Telogen effluvium can present as acute or chronic hair fall with symptoms such as trichodynia. Diagnostic tests that can be used include hair wash test, trichogram, phototrichogram, and scalp biopsy. In the treatment of telogen effluvium, it is essential to identify and remove the causative factors and to use drugs such as corticosteroids, minoxidil, and novel treatments such as CNPDA (caffeine, niacinamide, panthenol, dimethicone, and an acrylate polymer). Herein, we discuss the presentation, diagnostic approaches, and effective treatment options available for telogen effluvium.

Telogen effluvium: a sequela of COVID‐19

“…The telogen phase lasts approximately 3 months, after which excessive hair loss ensues. 3 Herein, we present 10 patients with concerns of increased hair loss following SARS-CoV-2 infection (…”

Acute telogen effluvium associated with SARS-CoV-2 infection

“…A trichogram (the plucking of 40-60 hairs and posterior microscopic analysis of the hair bulbs to discern how many of them are in anagen or telogen phase, considered consistent with telogen effluvium if more than 25% are in telogen phase) was performed, showing 35% of telogen follicles. 2 The patient was diagnosed as having acute telogen effluvium. We hypothesise that the trigger could have been her SARS-CoV-2 infection three months prior to this event.…”

“…Other aetiologies that may lead to acute telogen effluvium are surgeries, diets and other stressing pathologies or infections. 2 Patients typically report significant hair loss and a decrease in hair volume (they commonly complain about their ponytail reducing in diameter) without well-defined alopecic patches. A pull test is typically positive.…”

“…2 The main differential diagnosis in this case (a diffuse non-scarring alopecia) would be androgenic alopecia (trichoscopy would typically show anisotrichosis, with more than 10% of miniaturised hairs in the frontal area; this was not seen in our patient), diffuse alopecia areata (trichoscopy would typically show signs of alopecia areata, such as black or yellow dots, exclamation mark hairs or tapered hairs) or chronic telogen effluvium (defined as a telogen effluvium that lasts for >6 months, sometimes due to iron deficiency or hypothyroidism, among other causes). [2][3][4] The clinical presentation and the evidence of a well-defined trigger is almost always diagnostic of telogen effluvium and does not require biopsy (as in this case). When there are doubts about other possible aetiologies, a punch biopsy from the scalp can be taken.…”

“…The histopathology of telogen effluvium would typically show a normal total number of hairs with an increase in the telogen count to >20% of hairs and an absence of scarring or inflammation. 2 There is no specific treatment for acute telogen effluvium, as it is a reversible type of alopecia and resolves after cessation of the trigger. 2 By sharing this case, we hope to improve the knowledge of non-dermatologist physicians on acute telogen effluvium, a cause of common dermatological consultation that will likely become even more frequent because of the stressing events associated with the pandemic (both the infection and the psychological stress of confinement).…”