1. The interval between the precipitating event and the onset of shedding corresponds to the length of the telogen phase, usually 3 months [can be 1-6 months]
2. Acute illness – febrile illness, severe infection, major surgery, severe trauma, etc.
3. Chronic illness- malignancy [especially lymphoproliferative disorders], systemic lupus erythematosus, end-stage renal disease, liver disease, HIV
4. Hormonal change- pregnancy and delivery [can affect both mother and child], hypothyroidism, and discontinuation of hormonal pills
5. Change in diet like crash dieting, anorexia, low protein intake, and chronic iron deficiency
6. Sudden weight loss
7. Heavy metals such as selenium, arsenic, and thallium
8. Medications-ACE-inhibitors, anticoagulants, beta-blockers, contraceptives, retinoids, immunization
9. Allergic contact dermatitis of the scalp
- Thinning of hair which involves the entire scalp; sometimes in public and axillary regions
- Gentle hair pull may be positive for two or more hair shafts per pull-telogen hair
Investigations: CBC, Ferritin, ESR, TIBC, TSH, T3 T4 etc. are done as per the cause.
- Assess for etiology: Evaluate medication list, history, precipitating events, thyroid, anemia, etc. and correction of the same with oral medication.
- Topical minoxidil, stem cell, and peptide preparations are also helpful in the hair regrowth.
- Mesotherapy with special mesococktails is also used for regrowth of hair.
- Platelet-rich plasma (PRP) has been tried for treatment with good results.
- Stem cell treatment gives satisfactory results in 4 to 6 sessions.
PEARLS AND PITFALLS
- A chronic form of telogen effluvium can rarely occur and is a diagnosis of exclusion
- Regrowth take smonths to years [in some cases]