What is Telogen Effluvium?
Telogen Effluvium is a type of Alopecia that often causes diffuse hair loss on the scalp. Diffuse hair loss is widespread on the scalp rather than a predetermined pattern commonly found in Androgenetic Alopecia or coin-shaped balding spots in Alopecia Areata.
Where the average person may lose 50-100 hairs per day, people suffering from Telogen Effluvium may lose up to 300 hairs in a single day, causing a slow but perpetual hair loss.
Many patients develop Telogen Effluvium through stressors or “triggers.” These stressors can be from physical and psychological circumstances, including illness, menopause or medication. However, in 30% of cases, Telogen Effluvium can be diagnosed with no apparent cause, making it idiopathic.
In addition, Telogen Effluvium usually causes hair loss three months after experiencing a trigger. The three-month delay is due to the time it takes for hair loss to occur after the hair in question is forcefully transitioned from its anagen phase (hair growth) to its telogen phase (resting phase) following a trigger.
Furthermore, Telogen Effluvium is acute in most cases, meaning it will persist for up to 6 months. However, in rare instances, Chronic Telogen Effluvium may be diagnosed, in which the hair loss continues longer than six months and possibly for years.
How is Telogen Effluvium diagnosed?
One reliable indicator in the diagnosis of Telogen Effluvium is a look into its symptoms. A predominant symptom of Telogen Effluvium is Trichodynia, which gives rise to complications such as tenderness, burning, pain, itching, stinging and naturally, diffuse Alopecia.
Another reliable indicator used to diagnose Telogen Effluvium is an office procedure known as “the modified wash test” that allows for the identification of Telogen Effluvium in patients (along with its severity). For this procedure, you must abstain from applying shampoo for five days before washing and rinsing your hair in a sink with the plug covered by a gauze. Following this, hair is collected and left to dry before being sent to a laboratory via envelope. A lab technician then counts the number of shed hairs and the percentage of vellus hair (peach fuzz).
Patients with over 100 shed hairs, less than 10% of them being vellus hairs, indicate a diagnosis of Telogen Effluvium. Likewise, if you shed less than 100 hairs, you would not be considered a sufferer of Telogen Effluvium.
How does stress induce Telogen Effluvium
Scientists agree that stress induces hair loss in humans among many mammals. However, the exact blueprints remain unknown. Though the application of modern research in humans remains deficient, tests carried out on rats have been quite conclusive. If current knowledge found in the experimentation of rats reflects in humans, information regarding how stress induces hair loss below will be definitive.
Telogen is caused by “triggers”, which are events or circumstances that induce extreme stress. Some common triggers are surgical trauma, high fevers, chronic systemic illness, haemorrhages and potentially childbirth.
In the case of childbirth, a diagnosis of a telogen effluvium derivative called Telogen Gravidarum is appropriate. Like Telogen Effluvium, Telogen Gravidarum symptoms (hair loss) often develop two to three months after the stressor (child’s birth).
Extensive environmental stress, named “triggers” (mentioned above), increases cortisol levels and reduces hair growth by forcing an alteration in the life cycle of the hair.
Cortisol is a stress hormone produced by Adrenal glands (or suprarenal glands) in the kidney.
If Cortisol is removed from the body, hair growth peaks, returning to its highest possible rate regardless of age.
Cortisol defiles a cluster of cells underneath the hair follicle called the dermal papilla by preventing the dermal papilla from secreting GAS6, a chemical compound required to activate hair follicle stem cells (necessary for hair growth).
Current hypotheses suggest that a peptide drug called Substance P may stimulate the secretion of Cortisol.
In theory, the administration of a Substance P receptor (like NK 1) may be able to abrogate the hair-growth-inhibiting drug in humans.
How can Telogen Effluvium Cause shedding
The hair’s life cycle splits into three phases: Anagen (growth phase), transitional, catagen (transitional phase), and telogen (resting phase). In cases of Telogen Effluvium, the hair’s natural life cycle is interrupted and commandingly transposed.
There are five known mechanisms by which the hair’s life cycle can alter, causing hair to shed. These ways are as follows:
- Short anagen syndrome: Most commonly found in chronic cases of Telogen Effluvium, short anagen syndrome occurs due to an idiopathic shortening of the anagen phase, leading to a perpetual Telogen Effluvium.
- Immediate anagen release: An early anagen release attributes to an underlying cause where follicles leave the anagen phase before prematurely entering the telogen phase. The hasty transition will result in an increase in hair shedding following a three-month downtime.
- Delayed anagen release: Delayed anagen release may occur following a prolonged anagen phase, resulting in heavy shedding in the telogen phase.
- Immediate telogen release: An immediate telogen release may occur following a shortened telogen phase, causing the shed of many club hairs (hairs with a keratin-filled bulb attached).
- Delayed telogen release: A delayed telogen release stems from a prolonged telogen phase alongside a delayed transition back to the anagen phase.