Telogen effluvium

Definition/diagnostic criteria Telogen Effluvium (TE) is a non-scarring, temporary hair loss condition characterised by an increased shedding of telogen hairs from the scalp, resulting in diffuse hair thinning. The condition is typically triggered by a variety of systemic or local factors, leading to a disruption of the normal hair growth cycle. To diagnose TE, GPs should consider the following diagnostic criteria:

• Increased hair shedding: Patients often report increased hair shedding when combing or washing their hair. This shedding may be substantial, leading to noticeable hair thinning.
• Recent trigger: TE is often precipitated by a trigger, such as childbirth, severe illness, surgery, or psychological stress. GPs should inquire about recent events or medical conditions that may have contributed to hair loss.
• Normal scalp examination: The scalp should appear normal upon examination, without signs of scarring, inflammation, or alopecia areata.
• Duration: TE typically presents as acute hair loss within the past 6 months, but it can become chronic if the underlying trigger persists.

Epidemiology TE is a common hair loss disorder in the UK, affecting individuals of all ages and genders. It has been reported that up to 30% of people may experience TE at some point in their lives. The condition is more prevalent among females, with a peak incidence between the ages of 30 and 60 years. Pregnancy-related TE, known as postpartum alopecia, is a well-recognised variant of TE, affecting many women shortly after childbirth.

Diagnosis
Clinical features: Clinical features of TE include diffuse hair thinning, which is more pronounced on the crown and parietal regions of the scalp. Patients may complain of increased hair loss when brushing or washing their hair. However, the scalp usually appears normal without signs of erythema, scaling, or scarring.

Investigations:

• Patient history: A thorough patient history is essential to identify potential triggers such as recent illnesses, medications, emotional stress and dietary changes. Any ongoing or recent medical conditions should be assessed.
• Physical examination: A physical examination should focus on the scalp to rule out any signs of scarring or inflammatory conditions. GPs should also check for hair pull tests, which may reveal an increased number of telogen hairs when gently tugging on a small section of hair.
• Laboratory tests: Tests should include a full blood count (FBC), serum ferritin, thyroid function tests (TFTs), vitamin D and hormone profile if indicated (e.g. if features of PCOS).

Treatment The management of TE primarily involves addressing the underlying trigger and supporting hair regrowth. GPs can consider the following treatment strategies:

• Identify and address triggers: If a specific trigger is identified (e.g., iron deficiency), appropriate treatment or lifestyle modifications should be recommended.
• Patient education: Patients should be educated about the self-limiting nature of TE and the need for patience as hair regrowth can take several months. They should also be reassured that the condition does not typically lead to baldness.
• Topical minoxidil: In some cases, GPs may consider recommending over-the-counter topical minoxidil (2% or 5%) to stimulate hair regrowth. Patients should be advised on proper application techniques and expected timelines for results.

Prognosis Most cases resolve spontaneously once the underlying trigger is addressed or removed. However, it may take several months for patients to notice significant hair regrowth. Chronic TE may require more extended management, including ongoing treatment and monitoring for underlying medical conditions.