Telogen Effluvium

What is telogen effluvium?

Telogen effluvium is a common type of hair loss in which there is increased shedding of hair from all over the scalp. It happens when a large number of hair follicles move into the resting (telogen) phase of the hair growth cycle at the same time, and those hairs then fall out together a few months later. It is normal to lose between 30 and 150 hairs a day, and in telogen effluvium this increases considerably.

Who gets it?

Men and women of all ages can develop telogen effluvium.

What causes it?

Normally, most scalp hairs are in a growing phase, and only a small proportion are resting and ready to shed. A physical or emotional shock to the body can push many more hairs into the resting phase at once.

Common triggers include childbirth; high fever or significant illness, including COVID-19 and other infections; surgery or a general anaesthetic; crash dieting or rapid weight loss; scalp skin conditions; significant emotional stress or bereavement; low iron levels; thyroid disease; and starting or stopping certain medicines, including some hormonal contraceptives.

Shedding usually starts suddenly, around three months after the trigger, which means the cause is often not obvious unless you think back. In about 1 in 3 people, no cause can be found.

Is it hereditary or contagious?

Telogen effluvium is not inherited and is not contagious.

What does it look and feel like?

People notice more hair than usual coming out when brushing, washing or on the pillow, sometimes in large amounts. The hair feels thinner overall, and the ponytail may be smaller, but there are no bald patches. There may be short regrowing hairs along the hairline. The scalp itself looks normal, although some people describe tenderness or tingling of the scalp.

How is it diagnosed?

Diagnosis is based on the history of shedding and the timing of possible triggers, along with an examination of the scalp. A gentle hair pull test may show that several hairs come out easily. Blood tests are often recommended to look for low iron, thyroid problems or other contributing factors. Telogen effluvium can occur alongside pattern hair loss, which can make the picture more complex.

What are the treatment options?

Dr Mounsey will confirm the diagnosis, examine the scalp with a dermatoscope and arrange blood tests to look for treatable causes, such as low iron, thyroid problems or vitamin deficiencies. Treatment focuses on correcting any cause found and reassurance, as hair usually regrows once the trigger has passed. Minoxidil may be suggested in some cases to support regrowth. He will also check for other types of hair loss that can occur at the same time, such as pattern hair loss.

What is the outlook?

Telogen effluvium does not cause baldness. The shedding phase usually lasts three to six months, after which new hair regrows. Most people recover completely without treatment, although it takes several months for the hair to return to its previous thickness. In some people, shedding continues for longer than six months, which is called chronic telogen effluvium. This tends to fluctuate but also does not lead to baldness.

More information

British Association of Dermatologists patient leaflet: https://www.bad.org.uk/pils/telogen-effluvium

This page gives general information only and is not a substitute for a consultation. Everyone's skin is different, and what is right for you will depend on your own circumstances. If you are worried about a skin problem, please book an appointment with Dr Mounsey or speak to your GP. If you have a mole or skin lesion that is changing, bleeding or growing quickly, please seek medical advice promptly.