Understanding Hair Loss : Telogen Effluvium

Dr Erum Ilyas discusses Telogen Effluvium

September 07, 2020

 
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Stress related hair loss, referred to medically as Telogen Effluvium, is a very common condition. The reason why it is exceedingly common is simply because any stress can trigger this type of hair loss.  The most common stresses are major life changes such as job loss, new job, new home, relationship issues, loss of a loved one.  Major health changes such as post partum or illnesses such as the flu, likely COVID in the next few months are also common.  And, lastly, aggressive weight loss, extreme exercise, long distance travel, diet changes can also lead to this hair loss.


How much how does the average person lose a day?


 
The answer to this often surprises people! It is actually normal to lose between 50-200 hairs a day with most people probably in the 50-100 hairs a day. We often notice when in the shower or brushing our hair but shedding is occurring throughout the day.


Most people have a general sense of what ‘normal’ is for them. It can be alarming to see high volumes of hair loss at one time. Actually, if you are ‘witnessing’ the loss- meaning you actually see the strands in your hands and they have the little white bulb at the end, then you are likely experiencing telegenic effluvium. This is a temporary cycle change to the hair where we go through a shedding phase.






If you suddenly notice a patch of hair is just missing and it has a well defined shape to the patch like a circle or an oval, then you may be experiencing alopecia areata, an autoimmune type of hair loss. For those with a lot of inflammation and itching in their scalp, this can be autoimmune or the result of irritation from a product. It’s good to tell the difference between hair breakage (breaks easily with frequent chemical use) and loss (from the scalp). 


Many people note a seasonality to their hair loss. I often hear that some people ‘expect’ to shed in the fall for example. Season changes may act as a stress on our bodies that can trigger this cycle change to hair growth.   
Any stress on our body - physical, mental or emotional- can shift the cycling of our hair growth.


What is considered  "normal" for cycles of hair growth?


My routine discussion with patients is to review ‘normal’  hair cycles and the impact of stress on this pattern. Normally, 80-90% of our hair is growing while 10-20% is ‘resting’. The pattern is random and you will likely not notice this.




When a stress impacts the body - anything qualifies, physical, mental or emotional- then the cycle shifts. Now it could be that 50% are growing and 50% are resting. Actively growing hairs are deeply ‘planted’ in the scalp. When they enter the resting phase it takes about 3-4 months for these hairs to start to fall out. The shedding occurs on a delay of about 3-4 months after the stress. Interestingly, the hairs only fall out 
when a new hair is growing behind it to push it out! Ironically, people are usually stressing out during the recovery phase because they panic that they will lose all of their hair.




 In a nutshell...

Under normal circumstances, most of our hair is in the growth phase called the Anagen phase.  As much as 80 to 90% of our hair can be in this phase, randomly throughout our scalp.  This phase can last somewhere between 3 to 7 years for each hair follicle. 

 

The other 10 to 20% is in the resting phase of hair growth referred to as the Telogen phase. 

 

When a major stress occurs- this can be physical, mental, or emotional stress- the growth cycle can change. 

 

Hair follicles that had been in the anagen or growth phase will suddenly shift to the telogen or resting phase.  Initially, the hair loss that can accompany this growth phase shift is not often noted immediately as our hair is deeply rooted in our scalp.

 

Over the course of 2-4 months, these hair follicles reenter the anagen or growth phase again.  Now, the new hair follicle developing will grow and start to push out the old hair follicle.  This is when hair shedding is noted - the old hair follicles start coming out and this little white bulb is noted at the end of it.  Because of the time delay, many people do not connect the dots between the stressful event and the actual onset of hair loss.  This is usually the point when people come in to be seen.  They feel like their hair is falling out so quickly that they cannot imagine they will have any hair left over.  Ironically, this is the point when new hair is actually growing in and is technically closer to the recovery phase.  





The new hair is fine and tapered and gets coarser and thicker as it grows longer (just like a blade of grass). It takes about a year to recover. This can be a long year!! If it is persistent or unclear what the trigger was, blood work can help identify reversible causes of hair loss from the thyroid or vitamin deficiencies.


The best treatment in my opinion is knowledge. Understanding hair loss is so important because the stress of hair loss often leads to more hair loss! If it is telogen effluvium then recovery will often occur without treatment and just time alone.  The most beneficial option for management is minoxidil. Although many recommend Biotin, it is best to use with the caution that FDA issued an alert last year that it can affect lab tests.
If there was an illness or a period of extreme dieting or weight loss that triggered the hair loss, taking a routine multivitamin is reasonable.  If there is a concern about a particular vitamin deficiency, having blood work with your Dermatologist can identify the particular deficiency and consider supplementation to replace this.  
In terms of over the counter interventions, considering minoxidil is not unreasonable as it can assist with triggering hair growth. 

Talk to your Dermatologist about this process and really understand it.  The stress of hair loss routinely leads to more hair loss.  When a person experiences hair loss they become very vulnerable and start spending money unnecessarily on products with false promises and hopes for hair growth. I have seen people spend thousands of dollars without understanding what is happening and how important time is in the recovery phase.  It can take upwards of a year to really appreciate the hair regrowth.  This is simply because the new hair growing in is like ‘peach fuzz’ or ‘baby hair’ - it is fine, wispy and unmanageable.  As it grows longer it will get thicker and coarser and start to look and feel the way it used to.  This takes time. Watching hair grow is like watching water boil or grass grow- it’s a slow process!  I sincerely wish there was a magic wand that could speed this up but it’s truly time.  Many people who attribute success to a particular product they used may not realize that they happened to have used it closer to the time period when their hair was going to grow back anyway.  Once you discuss your hair loss and concerns with your dermatologist, most people can find themselves at ease and far more confident from the conversation than any product can offer.







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