Hair loss is a normal physiological event in an individual's life. However, the loss of more than 100 strands per day is an alarming health condition. Telogen effluvium is indicated by the increased loss of hair with white bulbs at the hair roots. Multiple trigger factors are responsible for the onset of telogen effluvium.
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What's a normal hair growth cycle?
The normal hair cycle in humans primarily comprises three distinct stages of varying durations, morphology, and physiology of hair. A brief description of each phase of the hair cycle is given as follows:
The anagen phase is also referred to as the growth phase of the hair cycle. The total duration of the anagen phase is approximately 2 to 6 years depending on the hair type. The longer duration of the anagen phase in the scalp hair justifies the longer length of the scalp hair. At a given time, approximately 85-90% of the total scalp hair is present in the anagen phase of the hair cycle.
During this stage of the hair growth cycle, hair follicle cells undergo rapid proliferation and melanocytes actively synthesize melanin pigment. The extracellular matrix of the anagen hair follicles increases in concentration and the dermal papilla also increases in thickness. The hair shaft grows longer during the anagen phase.
The hallmark of the catagen or transitional phase of the hair cycle is follicular regression. The hair follicles regress towards the surface of the scalp. During this phase, the proliferation of hair follicle cells ceases and the melanocytes cease to synthesize melanin pigment. The root bulb of the hair follicle shrinks and forms a club-like structure present at the hair roots.
The formation of club hair during this phase of the hair growth cycle is an important diagnostic and prognostic marker of hair-related pathologies. The Catagen phase may last for approximately 2-3 weeks.
Telogen or resting phase of the hair growth cycle is characterized by a dormant hair follicle with complete cessation of hair growth. Despite the absence of hair growth, the hair strands remain attached to the hair follicles. Approximately 10-15% of the total body hair is present in the telogen phase at a given time. The duration of the telogen phase for scalp hair is up to one year.
The telogen phase is terminated once the dead hair sheds on its own or is influenced by the underlying hair in the anagen phase of the hair cycle. During this phase, hair loss may occur during washing and brushing of hair. The exogen phase is an extension of the telogen phase of the hair growth cycle, during which, the hair shaft is liberated from the hair follicle and the hair eventually falls off.
Is your hair loss normal?
The normal amount of hair strands that are lost every day ranges from 50 to 100. Loss of more than 100 hairs each day is alarming and indicates the presence of an underlying pathology, commonly known as telogen effluvium. Assessment of the magnitude of hair loss and morphology of hair shed is important to reach a definitive diagnosis.
A modified wash test (MWT) is a useful tool in the measurement of daily hair loss. This test requires the individuals 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.
Hair shedding between 10 and 100 hair strands indicates androgenetic alopecia whereas loss of more than 100 hair strands every 5 days indicates telogen effluvium, although, this may vary among different individuals.
What is the white bulb when your hair fell?
The hair bulb morphology plays a significant role in distinguishing between different forms of hair loss - telogen effluvium, alopecia areata, and anagen effluvium. Significant shedding of hair with a white bulb at the roots is indicative of telogen effluvium. The white bulb does not represent hair follicles but the proteins that make up the remaining hair strand.
As the hair follicles transition from anagen to telogen phase of the hair growth cycle, the melanin synthesis is halted. Owing to a lack of melanin pigment, the hair bulb appears white. The shedding of hair during the telogen phase is also indicated by the club-shaped hair bulb that is present at the hair root.
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. Older adults 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 down below.
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.
What are the Causes of Telogen Effluvium?
Following are the different triggering factors that disrupt the hair growth cycle and give rise to telogen effluvium.
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 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.
Hyperthyroidism, hypothyroidism, autoimmune disorders, inflammatory conditions, systemic amyloidosis, renal failure, and hepatic failure may also give rise to telogen effluvium.
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 trigger telogen effluvium.
Increased exposure to solar UV radiation causes damage to the hair follicles and hair strands. This disrupts the hair growth cycle and leads to excessive shedding of hair.
How to Treat Telogen Effluvium?
Acute telogen effluvium is a self-limited hair loss condition. This resolves upon withdrawal of the triggering factor(s). Medications shall be associated with hair loss shall be discontinued and scalp conditions must be treated. Chronic telogen effluvium treatment required the identification and elimination of multiple triggering factors that are responsible for eliciting hair loss during the telogen phase.
However, if you still want to treat this hair fall, there are some hair restoration methods you can try:
You should educate yourself and consult with an expert to manage your hair thinning in telogen effluvium.
Dietary deficiencies might cause hair breakage and thinning hair. It's important to consume a healthy diet for healthy hair and hair regrowth.
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 must be avoided.
Catagen-inducing disorders including thyroid abnormalities and androgen disorders shall be treated to resolve telogen effluvium.
The topical application of 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 includes caffeine, niacinamide, panthenol, dimethicone, and acrylate polymer. This combination therapy increases the scalp hair density in patients suffering from telogen effluvium.
Hair transplant is also a great option if you want a hair loss treatment for male pattern hair loss and female pattern hair loss.
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. Removal of these triggering factors and the use of catagen-inhibiting medications aid in the resolution of telogen effluvium.