Why Is Your Hair Falling Out With White Bulb?

Medically reviewed by Dr. Ahmad Chaudhry M.B.B.S.
Written by Our Editorial Team
Last updated

Hair loss is a normal physiological event in an individual's life. However, the loss of more than 100 strands per day can become a cause for concern.

Telogen effluvium is a condition where one suffers from excessive amounts of hair falling out with the white bulb at the root (or hair at the telogen phase). Multiple trigger factors are responsible for the onset of telogen effluvium.

Summary

Telogen effluvium is a reversible hair loss condition that usually resolves sometime after withdrawal of the triggering event.

These triggering factors include medications, physiologic stress, systemic medical conditions, exposure to ultraviolet radiation, and dietary deficiencies.

The removal of these triggering factors and the use of catagen-inhibiting medications aid in the resolution of telogen effluvium.

    Is your hair loss normal or are you experiencing increased hair loss?

    The normal amount of hair strands everyone loses per day can range from 50 to even 100. When the number of you falling hair is between these values, they shouldn’t have any impact on your appearance whatsoever.

    However, it is when you experience hair loss at numbers higher than these that it may be time to reevaluate your health.

    Increased hair loss may indicate the presence of an underlying scalp disorder like telogen effluvium. But don’t be so quick to judge.

    It is only after the proper assessment of hair loss magnitude and hair shed morphology that one should reach a definitive diagnosis. 

    The modified wash test (MWT)

    Here’s one test you can do at home: the modified wash test or MWT. The modified wash test is a useful tool in the measurement of daily hair loss.

    This test requires the individual to abstain from hair washing for a total duration of 5 days and then shampoo their hair in a basin with the bottom covered by a filtering napkin to capture the lost hair. 

    When you interpret your results, know that the top limit for normal shedding is 100.

    A value higher than this may indicate androgenetic alopecia, also known as pattern hair loss, whereas loss of more than 100 hair strands every 5 days can indicate telogen effluvium, although cases may still vary among different individuals.

    Read more: Does Washing Hair Everyday Cause Hair Loss?

    What is the white bulb when your hair fell?

    hair anatomy white bulb hair

    The morphology of hair follicles plays a significant role in distinguishing between different forms of hair loss like telogen effluvium, alopecia areata, and anagen effluvium.

    Let’s go to the white bulb you can see sometimes from in shed hair. This bulb is called the hair bulb.

    The hair bulb is made up of keratin, the very same proteins that also make up the rest of the hair strand.

    As the hair follicles transition from anagen (active growth period) to telogen (resting period) phase of the hair growth cycle, the melanin synthesis is halted. Owing to a lack of melanin pigment, the hair bulb appears white. 

    You can know if your fallen hair is at its telogen phase when there is a club-shaped hair bulb present at the end of the hair root.

    When this white bulb falls off along with the hair strand, it means that the strand was at its telogen phase where it has become fully keratinized.

    When you experience excessive shedding of hair with this white bulb at the roots, this can be a sign of telogen effluvium.

    Read more: Seasonality of Hair Shedding: Why Your Hair Falls More in Autumn and Spring

    One culprit to hair falling out with the white bulb: Telogen effluvium

    Telogen effluvium is among the most common scalp disorders predominantly affecting the female population. This form of alopecia is characterized by non-scarring, diffuse, and excessive hair shedding. 

    Most of the hair loss cases are subclinical and do not come to physicians' and/or patients' attention. Telogen effluvium also affects certain age groups: older groups are more susceptible to telogen effluvium than younger individuals.

    Acute telogen effluvium refers to hair shedding that lasts for less than six months. The onset of hair shedding is noticeable about two to three months after the exposure to a stressor, however, remission is seen in approximately 95% of the telogen effluvium cases.

    Hair loss associated with pregnancy is one form of telogen effluvium, also known as telogen gravidarum.

    On the contrary, chronic telogen effluvium occurs when hair shedding exceeds six months. This mostly occurs in middle-aged women and presents as a prolonged fluctuating form of hair loss.

    The resolution of chronic telogen effluvium is indicated by the regrowth of hair in frontal and temporal regions of the scalp with normal thickness. Most of these cases are idiopathic. 

    Telogen effluvium arises due to disruption of the hair growth cycle and may be triggered by intrinsic and extrinsic stressors. The five probable mechanisms of shedding in telogen effluvium are listed below.

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    Immediate Anagen Release

    This mechanism of hair shedding is characterized by premature progression of follicles from the anagen to the telogen phase of the hair cycle. This is followed by extensive hair shedding two to three months after the stressful event.  

    Delayed Anagen Release

    This mechanism implies an increased duration of the anagen phase of the hair cycle. This is followed by excessive hair loss in the telogen phase.  

    Short Anagen Syndrome

    This is characterized by a shorter duration of the anagen phase that results in persistent telogen effluvium. This is also considered the underlying mechanism of chronic telogen effluvium. 

    Immediate Telogen Release

    As indicated by the name, immediate telogen release is referred to a shorter telogen phase and massive shedding of club hair.  

    Delayed Telogen Release 

    This is characterized by the shortening of the telogen phase of the hair growth cycle causing the hair follicles to progress to the anagen phase at a relatively slower rate.    

    patterns of telogen effluvium

    PATTERNS OF TELOGEN EFFLUVIUM 

     (Source: Medical, Surgical, and Cosmetic Treatments, Second Edition, Edited ByAmy J. McMichael, Maria K. Hordinsky)

     

    What are the Causes of Telogen Effluvium?

    Below are the different triggering factors that disrupt the hair growth cycle and give rise to telogen effluvium.

    Drugs

    Medications may be associated with hair shedding during the telogen phase, approximately 12 weeks after the intake of drugs. These drugs may include angiotensin-converting enzyme inhibitors, oral contraceptive pills, anticoagulants, antidepressants, and anticonvulsants.

    Physiological Stress 

    Physiological stress may cause a large volume of hair follicles to progress into the telogen phase. These stressors include high-grade fever, surgical trauma, hemorrhage, chronic systemic illness, and childbirth. The onset of telogen gravidarum occurs three months post-partum. 

    Medical Conditions

    Hyperthyroidism, hypothyroidism, autoimmune disorders, inflammatory conditions, systemic amyloidosis, renal failure, and hepatic failure may also give rise to telogen effluvium.

    Dietary Factors 

    Dietary deficiencies may trigger the onset of telogen effluvium. Fatty acid, zinc, protein, iron, vitamin D, and biotin or vitamin B7 deficiencies may lead to telogen effluvium. Caloric restriction, as well as chronic starvation states, may also bring about telogen effluvium.

    Read more: Fasting Hair Loss: Definition, Causes and Treatment Options

    Ultraviolet Radiation

    Increased exposure to solar UV radiation causes damage to the hair follicles and hair strands. This disrupts the hair growth cycle and leads to the excessive shedding of hair. 

    How do you treat telogen effluvium?

    Telogen effluvium can be considered a sign related to underlying conditions rather than a discrete disorder.

    Acute telogen effluvium is a self-limited hair loss condition. This resolves upon withdrawal of the triggering factor(s). Medications associated with hair loss should be discontinued and scalp conditions must be treated.

    Chronic telogen effluvium treatment requires the identification and elimination of multiple triggering factors responsible for eliciting hair loss during the telogen phase.

    However, if you still want to minimize the chances of your hair falling out with the white bulb, there are some hair restoration methods you can try:

    Consultation:

    Look up reliable online resources about hair loss to know more. You can also consult with a hair expert to manage excessive hair loss or hair thinning due to telogen effluvium.

    Diet:

    Dietary deficiencies might cause hair breakage and thinning hair. It's important to consume a healthy diet for healthy hair and hair regrowth.

    To ensure that you're getting the nutrients you need to strengthen your hair, we suggest Scandinavian Biolabs' Hair Nutrient Tablets, complete with hair-boosting extracts like:

    • Apple extract - to stimulate anagen hair growth
    • Amino acid complex - to boost keratin levels in hair
    • Horsetail extract - to improve tensile strength of hair strands
    • Vitamin B - to promote healthy red blood cells for hair growth
    • Vitamin C - to reinforce the structure of hair follicles

    But that's not even the best thing! These tablets are 100% vegan and lab-tested to deliver effective results!

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    Medication:

    If you currently have other health conditions and are taking medicine associated with hair loss, consult with your doctor about your medications to see if there are any alternatives you can take.

    Catagen-inducing medications including beta-blockers, antithyroid, anticoagulants, and retinoids are only some of the culprits when it comes to increased hair loss.

    Meanwhile, catagen-inducing disorders including thyroid abnormalities and androgen disorders should be treated to resolve telogen effluvium.

    However, neither minoxidil nor finasteride neither inhibit the catagen phase nor induce the anagen phase of the hair cycle.

    woman using hair growth serum for hair falling out with white bulb

    Corticosteroid:

    The application of topical corticosteroids reduces trichodynia among telogen effluvium patients. Topical corticosteroids reduce pain, tenderness, itching, and burning of the scalp, and are indicative of effective treatment of telogen effluvium.

    Systemic administration of corticosteroids treats telogen effluvium in patients suffering from systemic medical conditions.

    CNDPA therapy:

    CNDPA therapy includes caffeine, niacinamide, panthenol, dimethicone, and acrylate polymer. This combination therapy boosts the scalp hair density in patients suffering from telogen effluvium.

    Hair transplant:

    Hair transplant is also a great option if you want to permanently treat your male pattern or female pattern hair loss.

    However, hair transplants are costly and comes with its set of risks and cons, like the rejection of donor hair or severe scalp irritation.

    Read more:  The 12 Best Natural and Drug Hair Transplant Alternatives

    The Bio-Pilixin® Activation Serum

    If you want a more budget-friendly but just as effective solution to telogen effluvium, we only have rave reviews for this hair serum.

    The Bio-Pilixin® Activation Serum is a trademarked hair serum that stimulates new hair growth and reduces hair fall using only clean ingredients like:

    • Turmeric - to improve hair density
    • Niacinamide - to increase keratin levels
    • Aloe vera - to improve scalp hydration

    The Bio-Pilixin® Activation Serum is also tested by an independent third party, which found that it has an efficacy rate of 93% and is proven to reduce hair loss by 83%. 

    Read all about the study here.

    Product promises shouldn't be taken lightly and to assure you that the Bio-Pilixin® Activation Serum does indeed deliver, all product users get their money back if it doesn't work after 150 days!

    Bio-Pilixin® Activation Serum | For Women
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    References 

      1. https://www.ncbi.nlm.nih.gov/books/NBK499948/ 
      2. https://www.sciencedirect.com/topics/medicine-and-dentistry/hair-growth
      3. https://www.karger.com/Article/Fulltext/460300
      4. https://www.aad.org/public/diseases/hair-loss/insider/shedding 
      5. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6709511/ 
      6. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC2938572/#CIT5
      7. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC7320655/  
      8. Medical, Surgical, and Cosmetic Treatments, Second Edition, Edited ByAmy J. McMichael, Maria K. Hordinsky

      Dr. Ahmad Chaudhry M.B.B.S. is a House Physician in the Medical Unit 3 Allied Hospital, Faisalabad, and deals with hepatic, cardiac, neurological, and dermatological issues daily. He did his MBBS from Punjab Medical College, Faisalabad. He believes that a good haircare routine is one where you nourish it naturally. During his free time, he works as a dermatologist for Scandinavian Biolabs.