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Diagnosis and Causes of Telogen Effluvium

What are the causes and symptoms of telogen effluvium?

In addition to your medical history and clinical examination, your doctor may choose to run diagnostic tests. All of these will help rule out other types of hair loss (e.g., alopecia areata, androgenetic, scarring, and anagen, hair loss):(29, 122)

Although different than the typically more gradual but progressive hair thinning seen in androgenetic alopecia, on occasion telogen effluvium become chronic and may evolve into male patterned (common) balding and female patterned hair loss.29 Studies imply that about 60% of cases of telogen effluvium in women actually have clinical symptoms that suggest it is a precursor to androgenetic female pattern hair loss (FPHL). Sometimes FPHL is less patterned and more diffuse and can look like telogen effluvium.(20, 29)

In particular, differentiating between androgenetic patterned hair loss and telogen effluvium can be difficult at first glance (especially in women). Not only can they appear the same, but both can occur at the same time — sometimes with androgenetic alopecia as a triggering condition for telogen effluvium.(20, 29)

Diagnosing Hair Loss by Symptoms

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Some distinguishing symptoms include the following:(29, 30, 122, 170)

DIFFERENTIAL DIAGNOSES AT A GLANCE
SYMPTOMS
TYPE OF HAIR
  • Activated inflammatory proteins.
  • Evidence of yeast or fungal organisms on the scalp.
  • Patches of hair loss.
  • Total hair loss (on scalp, body, or both).
ALOPECIA AREATA
  • Decreased levels of estradiol and progesterone.
  • Excess DHT and testosterone levels.
  • High percentage of vellus hair.
  • Miniaturization of hair follicles.
  • Often patterned hair loss, but can also be diffuse.
ANDROGENETIC ALOPECIA
  • Areas of hair loss with smooth skin and no visible hair follicle openings.
CICATRICIAL ALOPECIA
  • Scalp inflammation and scaling rash on the scalp, such as in tinea capitis or seborrheic dermatitis (can also appear concurrently with androgenetic hair loss but is not a cause of it).
  • Sudden diffuse hair loss.
  • Clinical history that indicates the presence of a recent trigger known to cause hair loss.
  • Percentage of hair in telogen phase greater than 7-10%.
TELOGEN EFFLUVIUM

Once other types of hair loss are ruled out, the underlying condition causing telogen effluvium must be determined. This is because telogen effluvium is actually considered a symptom and not a primary disorder.(29)

Triggers Causing TE Hair Loss

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Telogen effluvium can involve multiple contributing factors, including:(2, 29, 32, 76, 127, 171, 172)


Common Causes of Telogen Effluvium

KNOWN TRIGGERS OF TELOGEN EFFLUVIUM
TYPE
PHYSICAL/MENTAL STRESSOR
CHRONIC MEDICAL
CONDITIONS, DISEASE,

OR

RECENT MEDICAL EVENT

Question: What chronic medical condition, disease, or recent medical event can cause TE hair loss?

Answer: Medical conditions or diseases that can cause diffuse thinning hair include the following:
PSYCHOLOGICAL STRESS

Question: What types of mood disorders or stressors can cause TE hair loss?

Answer: Mood disorders that can cause diffuse thinning hair include the following:

  • Acutely stressful event
  • Anxiety
  • Bipolar mood disorder
  • Depression
  • Stress due to the alopecia itself or other sources of chronic stress
MEDICATIONS

Question: What types of drugs and medications can cause TE hair loss?

Answer: Medications that can cause diffuse thinning hair include the following:

  • Drugs used to treat medical conditions associated with hair loss (such as medications for certain thyroid conditions)
  • Stopping "the pill" (oral contraceptives)
  • Excess vitamin A and/or retinoid intake
  • Medications other than chemotherapy drugs (e.g., anticonvulsants, beta-blockers for heart disease, interferon, and antidepressants)
NUTRITIONAL ISSUES

Question: What nutritional issues can cause TE hair loss?

Answer: Dietary problems or disorders that cause vitamin deficiencies that can cause diffuse thinning hair include the following:
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Different then localized discoid lupus erythematosus, which can cause scarring (cicatricial) permanent hair loss.(2)
Chemotherapy drugs are typically cytotoxic and cause anagen effluvium.(32)