“Telogen Effluvium: Stress and Hair Loss”

Hair loss can be a stressful experience. But what if stress itself can trigger hair loss? There are three types of hair loss associated with stress- Telogen Effluvium, Trichotillomania, Alopecia areata.

Shedding of hair due to stress
Image source: REPHAIR CLINIC

Does stress cause hair loss?

Stress or anxiety can trigger both physical and emotional symptoms, one of which is hair loss. When the body experiences stress, it releases a hormone called cortisol, which can interfere with the natural hair growth cycle. High cortisol levels may push hair into the telogen phase earlier than usual, resulting in hair loss.

What is Telogen Effluvium?

Telogen effluvium is a condition that can lead to the shedding of about half to three-quarters of scalp hair due to physical or emotional stress. You might notice hair falling out in large amounts when you shampoo, comb, or run your fingers through it. This hair loss often becomes noticeable several weeks to months after the stressful event.

Acute vs chronic Telogen Effluvium

  • Acute Telogen Effluvium: This type lasts less than six months, with hair loss typically occurring two to three months after a stressor. In 95% of cases, it resolves on its own.
  • Chronic Telogen Effluvium: This type lasts longer than six months and can affect the entire scalp. It may not have an identifiable cause. Hair loss can be significant in the early stages but typically does not lead to complete baldness.

Who is affected by Telogen Effluvium?

Telogen effluvium can affect anyone. However, chronic telogen effluvium is more likely to occur in women or individuals assigned female at birth (AFAB) who are between 30 and 60 years old. It is not a contagious disease.

Prevalence of Telogen Effluvium

Telogen effluvium is one of the most common causes of sudden hair loss, especially in women and AFAB individuals. Telogen effluvium can last upto three or six months. Hair typically regrows after telogen effluvium. New hair growth is usually noticeable three to six months after the shedding phase. 

How Telogen Effluvium Impacts Your body?

Telogen effluvium causes hair follicles to prematurely enter the resting phase from the growing phase. While healthy individuals typically lose up to 100 hairs a day, those with telogen effluvium may lose up to 300 hairs daily.

Although telogen effluvium primarily affects the hair on the top of the head, severe cases may impact the eyebrows and body hair. It is important to note that telogen effluvium does not affect physical health but can have psychological and social effects, including stress, anxiety, and depression.

Symptoms of Telogen Effluvium

  • A noticeable retreat in your hairline.
  • Enlarging bald patches.
  • Hair thinning.
  • Fractured hairs along the hairline, particularly around the forehead.
  • The natural part in your hair is widening.

Causes of Telogen Effluvium

  • Psychological stress
  • Acute febrile illness
  • Severe infection
  • Undergoing major surgery
  • Experiencing severe trauma 
  • Hormonal changes after childbirth (especially a drop in estrogen levels)
  • Hypothyroidism
  • Stopping oestrogen-based medications
  • Crash diets
  • Low protein intake
  • Exposure to heavy metals
  • Iron deficiency

Pathophysiology of Telogen Effluvium

The natural cycle of hair growth is divided into three phases:

  1. Anagen: This is the active growth phase.
  2. Catagen: A brief phase lasting about two weeks, during which the hair follicle begins to shrink.
  3. Telogen: This is the resting phase of the hair cycle, typically lasting around three months.
Hair growth cycle
Image source: ADVANCED Hair Studio

Telogen effluvium occurs when physiological stress causes many hairs in the anagen (growth) phase to suddenly shift into the telogen (resting) phase. During this period, hair growth stops for 1 to 6 months (typically 3 months), although this is not immediately noticeable. As the affected hairs return to the anagen (growth) phase, the hairs that were in the telogen phase are shed, leading to visible hair loss.

How to diagnose Telogen Effluvium?

Telogen effluvium is usually easy to diagnose through a physical examination of the scalp. A healthcare provider may perform a “pull test,” gently pulling a small group of 40 to 60 hairs. Normally, only two to three hairs may shed, but in telogen effluvium, four to six hairs with white bulbs at the roots can be pulled out.

Common treatments for Telogen Effluvium Hair Loss

Since telogen effluvium is often triggered by a stressor, identifying and addressing the cause is crucial. Most cases usually resolve on their own within six to eight months, without the need for treatment.

Although telogen effluvium often resolves on its own, some treatments may include:

  • Medications: Over-the-counter treatments like minoxidil (Rogaine®) can promote hair growth. However, side effects may include headaches, scalp irritation, and unusual hair growth. Minoxidil is not recommended for those who are pregnant or breastfeeding.
  • Multivitamins or Supplements: Supplements containing iron or biotin can promote healthy hair growth.
  • Styling Techniques: Certain hairstyles, wigs, or hair weaves can help hide hair loss.
  • Castor oil: Castor oil is commonly used as a home remedy for hair loss, though research supporting its effectiveness is limited. However, some anecdotal reports suggest that castor oil might promote hair growth.

How to reduce the risk of Telogen Effluvium?

To keep your hair healthy and minimise the risk of telogen effluvium:

  • Increase Protein Intake: Especially for vegetarians and vegans, aim for 40 to 60 grams of protein per day. The Mediterranean diet, rich in fruits, vegetables, and protein, may help reduce hair loss.
  • Certain vitamins, such as B, C, and E, play an essential role in promoting healthy hair growth and can also help in reducing stress. Vitamin B supports a healthy metabolism, skin, and hair growth, and is abundant in foods like nuts, beans, dark leafy greens, and avocados. Vitamin C is vital for collagen production, a key component in hair follicles. You can find vitamin C in foods like broccoli, bell peppers, citrus fruits, and strawberries. Vitamin E is rich in antioxidants that contribute to a healthy scalp and is present in spinach, sunflower seeds, olive oil, broccoli, and shrimp.
  • Manage Stress: Since stress is a leading cause of telogen effluvium, finding ways to manage stress is crucial.
  • Get Enough Sleep: Adults should aim for seven to nine hours of sleep per night, which can help reduce stress and promote overall health.
  • Avoid Extreme Diets: Rapid weight loss and restrictive diets can trigger telogen effluvium. Instead, focus on regular exercise and a balanced Mediterranean-style diet.

Focus keywords: Telogen Effluvium, Stress, Hair loss

Written by Liya Sunny

Source

https://my.clevelandclinic.org/health/diseases/24486-telogen-effluvium

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