VancodermadminTelogen Effluvium: Understanding the Causes, Diagnosis, and Effective Treatment
Faramarz Rafie MD / Vancoderm Academy and College / Vancoderm Clinic (VDCmed)
Telogen Effluvium
Telogen Effluvium (TE) is one of the most common causes of diffuse hair loss. It occurs when a large number of hair follicles prematurely shift from the anagen (growth) phase into the telogen (resting) phase of the hair cycle.
Normally, only about 5–10% of hairs are in telogen, but in TE, this number rises to 30–50%, resulting in excessive hair shedding. The good news? It’s usually temporary and reversible once the underlying cause is identified.
Etiologies of Telogen Effluvium
Telogen Effluvium can be triggered by physical, emotional, or metabolic stress. Common causes include:
- Severe illness or high fever (including post-COVID recovery)
- Childbirth (postpartum shedding)
- Surgery, trauma, or anesthesia
- Sudden weight loss or restrictive dieting
- Iron or vitamin D deficiency
- Thyroid imbalance (hypo- or hyperthyroidism)
- Emotional stress or anxiety
- Certain medications such as retinoids, beta-blockers, or oral contraceptives
Diagnosis:
Clinical signs:
- Diffuse hair shedding across the scalp (not patchy)
- Thinning ponytail volume
- Increased hair fall in shower or on pillow
- Healthy scalp without redness or scaling
Trichoscopic Findings in Telogen Effluvium
Trichoscopy is one of the most valuable non-invasive tools for diagnosing diffuse hair loss, helping to distinguish Telogen Effluvium (TE) from Androgenetic Alopecia (AGA) and other alopecias.
Below are the key trichoscopic features of Telogen Effluvium, along with explanations and differential comparisons.
Empty (Yellow or White) Follicular Openings
- Many follicular units appear empty or with fine vellus hairs.
- The openings remain visible — a hallmark of non-scarring alopecia.
- The absence of fibrosis or obliteration confirms that follicles are preserved.
- Color notes:
- Yellow dots → represent follicular infundibula filled with sebum and keratin.
- White dots → indicate open empty follicles seen under polarized light.
Diagnostic clue: Uniformly distributed yellow/white dots with preserved follicular ostia are typical in TE, unlike AGA, where yellow dots cluster in specific regions (frontal or vertex).
Increased Number of Short, Regrowing Hairs
- Presence of short regrowing hairs (0.5–2 cm) is a sign of recovery phase TE.
- These appear as upright short black hairs or tapered regrowing hairs.
- The lengths vary, showing asynchronous regrowth after the shedding event.
Diagnostic clue: In TE, regrowing hairs have normal shaft diameter and pigmentation — unlike AGA, where regrown hairs are miniaturized and thinner.
Uniform Hair Shaft Diameter
TE shows minimal or no hair shaft diameter diversity (<20%). This means most hair shafts appear similar in thickness and color. This feature helps differentiate TE from Androgenetic Alopecia, where variation in shaft diameter (>20%) is a key marker due to follicular miniaturization.
Reduced Hair Density and Follicular Units with Single Hairs
- Diffuse reduction in overall hair density is seen, especially on vertex and parietal areas.
- Follicular units that usually contain 2–3 hairs may show only one terminal hair.
- Despite reduced density, follicular openings remain visible and healthy.
Diagnostic clue: Uniformly reduced density across the scalp — not patterned — supports TE.
Absence of Signs of Inflammation or Scarring
- No perifollicular scaling, redness, or keratotic plugs.
- The interfollicular skin appears normal.
- These findings distinguish TE from scarring alopecias such as Lichen Planopilaris or Discoid Lupus Erythematosus.
Presence of Upright Regrowing Hairs or “Short New Growth” Pattern
- Common in subacute or resolving TE.
- Appears as multiple short, straight, upright hairs emerging — often with a healthy shine under polarized light.
- These indicate that follicles are actively recovering from telogen-to-anagen transition.
Occasionally Seen: Peripilar Sign
- A faint, brownish halo around some hair follicles (due to perifollicular pigmentation).
- Although not a dominant feature of TE, it may occasionally appear during regrowth.
- If prominent, it suggests overlapping early Androgenetic Alopecia rather than pure TE.
Hair Pull Test:
Positive if 4–6 or more hairs are easily extracted, suggesting active shedding.
Comb Test (Hair Pull / Hair Combing Test)
- Positive test: >6 hairs per comb stroke (some sources: >10 hairs per 50 hairs combed) indicates active telogen shedding.
- Hairs are typically club-shaped telogen hairs with no pigment at the tip.
- Shedding is diffuse, not in patches.
- May see a mix of short regrowing hairs along with shed telogen hairs. Notes:
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TE often gives a diffuse positive comb test, while Androgenetic Alopecia may only shed hairs in thinning areas.
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Should be repeated over a few days for accuracy.
Differential Diagnosis
- To confirm Telogen Effluvium, it must be differentiated from other hair loss types:
- Androgenetic Alopecia: Gradual thinning in frontal/crown areas; hair miniaturization
- Alopecia Areata: Sudden patchy loss; exclamation mark hairs
- Anagen Effluvium: Rapid loss due to chemotherapy or toxins
- Cicatricial Alopecia: Scalp inflammation and permanent scarring
Treatment and Management
Most cases of Telogen Effluvium resolve naturally once the trigger is addressed. However, early intervention helps accelerate recovery.
Identify and treat the root cause
Address nutrient deficiencies, hormonal imbalances, or medication effects.
Nutritional therapy
Diet rich in iron, zinc, biotin, vitamin D, and proteins supports follicle recovery.
Topical treatments
- Minoxidil (2–5%) helps stimulate regrowth.
- Stress management
Relaxation, sleep, and mindfulness can significantly improve hair health. - Professional care
A dermatologist or trichologist can provide diagnostic tests (like ferritin, thyroid, vitamin D levels) and personalized regrowth plans.
there are several adjunctive, non-pharmacologic treatments for Telogen Effluvium (TE) that can help accelerate regrowth, including scalp massage, light therapy, and ultrasonic stimulation. Here’s a detailed breakdown:
Adjunctive Treatment Options for Telogen Effluvium
Scalp Massage
- Purpose: Increases blood flow to hair follicles, improves oxygen and nutrient delivery, and stimulates mechanoreceptors that may promote follicle activity.
- Technique:
- Use fingertips to apply gentle circular pressure across the entire scalp for 5–10 minutes daily.
- Can be combined with oils containing biotin, peptides, or essential oils (like rosemary or peppermint) for added circulation benefits.
- Evidence: Small studies suggest regular scalp massage may improve hair thickness and density over time by enhancing microcirculation and mechanotransduction signaling.
Low-Level Laser Therapy (LLLT)
- Purpose: Stimulates follicles in the anagen phase, improves blood flow, and reduces inflammation around the follicle.
- Devices: Laser combs, caps, or helmets emitting 630–670 nm red light or 780–850 nm near-infrared light.
- Session Protocol:
- 2–3 times per week, 15–20 minutes per session.
- Safe for home use; eye protection recommended for higher-power devices.
- Evidence: LLLT has been shown to increase hair density and thickness in TE and androgenetic alopecia, especially when combined with topical therapies like minoxidil.
Ultrasonic or Low-Frequency Sonophoresis
- Purpose: Uses ultrasound waves to increase absorption of topical treatments and enhance follicle stimulation via microvibrations.
- How it works:
- Ultrasound vibrations may increase cell permeability, nutrient delivery, and local blood flow.
- Often used in clinics with topical serums containing growth factors, peptides, or minoxidil.
- Evidence: While clinical studies are limited, sonophoresis shows promise in improving penetration of topical agents and may mildly stimulate follicles.
Microneedling
- Purpose: Creates tiny punctures in the scalp to induce wound-healing responses and growth factor release, which can promote regrowth.
- Protocol:
- Small dermarollers (0.5–1.5 mm) once every 1–2 weeks.
- Often combined with minoxidil or platelet-rich plasma (PRP) for enhanced results.
- Evidence: Shown to improve hair density in chronic TE and androgenetic alopecia.
Combined Approach
Most trichologists recommend combining nutritional support + topical therapy (minoxidil) + adjunctive therapies like massage or LLLT for faster regrowth.
Adjunctive tools are safe, non-invasive, and enhance recovery but should not replace identifying and treating the underlying cause (stress, deficiency, thyroid disorder, etc.).
Prognosis
- Acute TE: lasts 3–6 months, followed by new growth
- Chronic TE: may last beyond 6 months, requiring ongoing management
- Regrowth is typically complete within 6–12 months once the cause is resolved
Conclusion
Telogen Effluvium is a sign of temporary imbalance, not permanent damage. With the right diagnosis, nutritional support, and trichological care, hair growth almost always recovers.
Vancoderm Academy and College:
We sincerely thank you for taking the time to read our blog and expand your knowledge on Telogen Effluvium and hair health. At Vancoderm Academy and College, we are proud to be a Canadian leader in Medical Aesthetics education, offering comprehensive training and professional treatment services. As a Designated Learning Institute (DLI) in Canada, we are approved by the Ministry of Post-Secondary Education and Future Skills, PTIRU, and Education Quality Assurance (EQA-IRCC), and our programs are eligible for BC Student Loans for Canadian students (Citizens, PR, Protected Person).
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Keywords: Telogen Effluvium, diffuse hair loss, hair shedding, trichology, hair regrowth, stress hair loss, post-COVID hair loss, Vancoderm Academy
Best wishes!