Sara Wilchowski, PA-C & Dr. Paul M. Graham
Hair loss is a very common reason for dermatology visits worldwide, but there is still a lot of confusion surrounding this topic. In this article we will discuss a very common condition called telogen effluvium, as well as touch on the basic hair anatomy and mechanism by which hair loss occurs. Furthermore, we will discuss several over-the-counter products that may help augment hair growth. Nonetheless, it is very important to visit your dermatologist for a comprehensive evaluation to determine the exact cause of hair loss.
The word “hair loss” is a generic term used to describe “the loss of hair from the body” but fails to give a specific reason why this occurs. There are two general reasons to be aware of that contribute: hair shedding and hair breakage. To understand how the hair sheds from the follicle, we must first know the basic anatomy of hair. Hair is made up of structural proteins called keratin, which are assembled to make the hair shaft. A single hair shaft is composed of the cuticle (outermost layer), the cortex, and the medulla (innermost layer). The cuticle is composed of “sticky” cells that hold the hair shaft into the follicle. If the cuticle is disrupted, the hair shafts are easily lost. When any of the layers are abnormal or disrupted, the hair shaft weakens, compromising its structural integrity and causing the hair shaft to break. Furthermore, the hair follicle is nourished by a collection of blood vessels called the dermal papillae. It is this structure that is primarily responsible for stimulating hair growth by supplying required blood and nutrients to the hair follicle.
The Hair Cycle: Anagen, Catagen, and Telogen
- Anagen phase: also known as the growth phase, last approximately 2-3 years and is responsible for actively growing hair (85-90% of all scalp hairs at any given time)
- Catagen phase: also known as the death phase, last approximately 2-3 weeks and is characterized by the loss of blood supply (resorption of the dermal papillae) to the follicle (<5% of all scalp hairs at any given time)
- Telogen phase: also known as the resting phase, last approximately 2-3 months and is characterized by slow shedding of the hair shafts over time (10% of all scalp hairs at any given time)
Now that we understand the specifics of hair development and progression, we can now discuss a very common condition known as telogen effluvium. Telogen effluvium (TE) is a temporary, non-scarring form of hair loss that occurs primarily in women between 30-6o years old. Hair loss typically occurs 2-3 months after an inciting stressful event, but sometimes the cause is unknown. The word “telogen” means resting phase and “effluvium” means outflow, simply describing the what occurs in this disorder. Telogen effluvium is characterized by a period of excessive shedding of telogen hairs simultaneously, contributing to diffuse hair loss. The most common causes of this form of hair loss can be remembered by the 4 B’s: bereavement, breakup, baby and bankruptcy.
Causes of Telogen Effluvium
- Severe and prolonged psychological stress
- Crash diets
- Major surgery
- High fever
- Severe infection
- Severe chronic diseases
Why Does This Happen?
In a normal day, we lose approximately 100-150 hairs per day. However, in telogen effluvium, that number typically exceeds 200 hairs per day contributing to rapid, diffuse hair shedding. After a stressful event, the hair cycle shifts from the growing phase to the resting phase, inevitably leading to hair loss. Ultimately, this hair cycle shift can lead to upwards of 80% of the entire scalp hair to be shed over several weeks. In more severe cases, hairs are also shed from the eyebrows and pubic region. Fortunately, this hair loss is temporary and typically resolves over 3-6 months.
It is important to note that these hairs are being shed from the root of the follicle and do not appear as short, broken hairs with varying lengths. Take a close look at the hairs being lost; do they have a whitish bulb on the end? Are the hairs all the same length? If so, this is a strong indication for telogen effluvium. If the hairs are varying lengths, then you may be suffering from brittle hair causing hair shaft breakage rather than hair shedding. Hair breakage occurs at any part of the hair shaft and can occur from long-term use of chemicals, heat, tight hair styles, and manipulation of the hair. The treatment of brittle hair is often accomplished by changing hair care practices, avoiding harsh chemicals, heat, and adding a moisturizing shampoo/conditioner to your regimen.
What Can I Do?
It is a common misconception about what can be done, given that this cycle will eventually reset itself and the hair loss will subside without any treatment needed. However, there are a several things you can do to help hasten the process. Currently, there is no hard evidence regarding the use of vitamins or oral supplements that have been shown to reverse hair loss, but we typically recommend taking a daily multivitamin in the event that nutrients are deficient. If you are currently going through or have suffered from a recent stressful event, stress-reducing techniques may be beneficial. As medications may have played a role, it is recommended to visit your physician to discuss this possibility. If you have experienced a recent injury, illness, or underwent a major surgical operation, it is important to be patient as the hair loss is only temporary and will resolve.
Below are several products that may be beneficial in those suffering from telogen effluvium. These products can be obtain over-the-counter at your local pharmacy.
Anaphase shampoo by Ducray
This shampoo may help prolong the growth phase (anagen phase) of the hair cycle.
There are two forms currently available: Rogaine or Qilib. These products are typically used for patients suffering from hereditary hair loss (androgenetic alopecia) but may be beneficial for patients suffering from telogen effluvium. Minoxidil works by increasing the blood and nutrient flow to the hair follicle via the dermal papillae, prolonging the growth phase of the hair cycle. This product may also help slow the progression of hair loss over time. The active ingredient, minoxidil, has been around for many years and is safe for topical application. The only side effect of this medication is unwanted hair growth on the face if the product is applied to facial skin. Rogaine comes in two concentrations: 2% and 5%.
Keranique Hair Regrowth System
This product contains a combination of shampoo, conditioner, and 2% minoxidil.
This supplement is controversial as leading experts in hair loss recommend only using in individuals who are biotin deficient. However, it is safe and may slightly augment hair growth. There are currently no clinical studies on the effectiveness of biotin in telogen effluvium.
Update August 30, 2017 – If you are interested in more hair loss treatment resources, check out this comprehensive guide: http://www.reviews.com/hair-loss-treatment/
If you are currently suffering from hair loss, make sure to schedule an appointment with your dermatologist for the correct diagnosis. Click here to locate a dermatologist in your area.
Photo Credit: Turmixvilag.hu, Koreesa.co.uk, Boldbarber.com, Ducray.com, Rogaine.com, Keranique.com
- American Hair Loss Association. Types of Hair Loss, Effluviums. Accessed October 27, 16 Available: http://www.americanhairloss.org/types_of_hair_loss/effluviums.asp
- Grover and A. Khurana, “Telogen effluvium,” Indian Journal of Dermatology, Venereology and Leprology, vol. 79, no. 5, pp. 591–603, 2013.
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