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Chronic Telogen Effluvium

Chronic Telogen Effluvium

Hair loss is a common issue that affects millions of people worldwide, but for many, it is a temporary problem. However, when hair shedding persists for an extended period, it can be classified as chronic telogen effluvium (CTE). This form of prolonged hair shedding can be distressing, affecting not only appearance but also emotional well-being. Understanding the causes, symptoms, and treatment options for chronic telogen effluvium is crucial for anyone facing this challenging condition.

What is Chronic Telogen Effluvium?

Chronic Telogen Effluvium (CTE) is a condition where excessive hair shedding occurs for more than six months. It is primarily characterized by diffuse thinning of the hair across the scalp rather than localized patches of hair loss. CTE occurs when a significant number of hair follicles enter the telogen (resting) phase of the hair growth cycle prematurely, leading to increased shedding. While acute Telogen Effluvium (TE) typically lasts for a few months and resolves once the triggering factor is removed, chronic telogen effluvium can persist for years.

The Hair Growth Cycle

To better understand chronic telogen effluvium, it’s essential to have a basic understanding of the hair growth cycle. Hair growth occurs in three main phases:

  1. Anagen (Growth Phase): The active phase of hair growth, where hair cells rapidly divide and produce new hair. Approximately 85-90% of the hair on the scalp is in this phase at any given time.
  2. Catagen (Transitional Phase): A brief period (about two weeks) when hair growth slows down and the hair follicle begins to shrink. Only 1-2% of hair is in this phase.
  3. Telogen (Resting Phase): During this phase, hair stops growing and rests for about two to four months before it sheds. Normally, about 10-15% of the hair is in this phase.

In individuals with chronic telogen effluvium, a larger proportion of hair follicles transition into the Telogen phase, resulting in noticeable hair thinning.

Causes of Chronic Telogen Effluvium

Treatment for Chronic Telogen Effluvium

The causes of chronic telogen effluvium are varied and can often be difficult to pinpoint. However, the condition is generally triggered by factors that disrupt the normal hair growth cycle. Some of the most common causes include:

  1. Nutritional Deficiencies: A lack of essential nutrients, such as iron, zinc, and vitamins (especially vitamin D and biotin), can result in chronic hair shedding. These nutrients play a critical role in hair follicle function and hair shaft production.
  2. Hormonal Imbalance: Hormonal changes caused by conditions such as polycystic ovary syndrome (PCOS), thyroid disorders (hypothyroidism or hyperthyroidism), menopause, or postpartum hormonal fluctuations can lead to chronic telogen effluvium.
  3. Chronic Stress: Persistent stress can negatively affect hair growth by pushing more hair follicles into the resting phase. The stress-induced increase in cortisol levels can interfere with the hair cycle.
  4. Medications: Some medications, including antidepressants, beta-blockers, anticoagulants, and certain hormonal treatments, can lead to prolonged hair shedding as a side effect. Abrupt changes in medication, including stopping birth control pills, can also contribute.
  5. Underlying Medical Conditions: Chronic diseases such as lupus, autoimmune disorders, and chronic infections can interfere with hair growth, causing extended periods of hair shedding.
  6. Significant Weight Loss: Rapid or severe weight loss, particularly when associated with crash diets or bariatric surgery, can deprive the body of essential nutrients and disrupt the hair growth cycle.
  7. Environmental Factors: Chronic exposure to environmental toxins, pollutants, or allergens can damage hair follicles, leading to chronic shedding.

Symptoms of Chronic Telogen Effluvium

The hallmark symptom of chronic telogen effluvium is diffuse hair thinning across the scalp. However, other common symptoms include:
  • Increased hair shedding, especially when brushing, washing, or styling the hair
  • A noticeable decrease in hair volume
  • Hair regrowth that is slower or less dense than usual
  • The overall hair quality may appear dull or less healthy
Unlike alopecia areata or androgenetic alopecia, chronic telogen effluvium does not result in bald patches or complete hair loss. The hair thinning is generally uniform across the scalp.

Diagnosis of Chronic Telogen Effluvium

Diagnosing chronic telogen effluvium involves ruling out other types of hair loss, such as androgenetic alopecia, which is genetic, or alopecia areata, an autoimmune condition. The diagnostic process typically includes the following steps:

  1. Patient History: A thorough medical history is taken to identify any potential triggers, such as recent illnesses, stress, diet changes, or medications. A discussion about family history of hair loss may also be conducted.
  2. Physical Examination: A dermatologist will examine the scalp to assess the extent of hair thinning. The scalp will appear normal, without significant inflammation or scarring.
  3. Hair Pull Test: This test involves gently pulling on a small section of hair to see how many hairs come out. In cases of chronic telogen effluvium, more than a few hairs are likely to shed.
  4. Scalp Biopsy: In some cases, a scalp biopsy may be performed to examine hair follicles under a microscope. This helps differentiate between telogen effluvium and other types of hair loss.
  5. Blood Tests: Blood tests are often ordered to check for underlying conditions, such as thyroid imbalances, iron deficiency, or hormonal disorders.
  6. Trichoscopy: A trichoscope (a type of dermatoscope) is used to examine the hair and scalp at high magnification, helping the dermatologist evaluate the health of hair follicles.

Treatment Options for Chronic Telogen Effluvium at FMS

The treatment of chronic telogen effluvium is highly individualized, depending on the underlying cause of the condition. Here are the most common Hair loss treatment approaches:

  1. Addressing Nutritional Deficiencies: Correcting nutritional deficiencies is one of the most effective ways to manage chronic telogen effluvium. Supplementation with iron, zinc, vitamin D, and biotin is often recommended, particularly if blood tests reveal a deficiency. A well-balanced diet rich in essential nutrients, including protein, healthy fats, and vitamins, can help support hair health and reduce shedding.
  1. Hormonal Treatment: If hormonal imbalances, such as thyroid disorders or PCOS, are the underlying cause of chronic telogen effluvium, managing these conditions is crucial. Thyroid hormone replacement therapy, hormonal treatments for PCOS, or medications to balance hormones can help restore the normal hair growth cycle.
  1. Stress Management: Since stress is a major contributor to chronic telogen effluvium, stress management is essential. Techniques like yoga, meditation, mindfulness, and regular exercise can help reduce stress and minimize its impact on hair shedding. In some cases, counselling or therapy may be beneficial, especially if stress is related to emotional or psychological factors.
  1. Medications: Minoxidil, a topical treatment commonly used for androgenetic alopecia, can also be helpful. It works by increasing blood flow to the hair follicles, stimulating regrowth, and prolonging the anagen phase. However, it should be used under medical supervision, as improper use can cause irritation or exacerbate shedding initially.
  1. Avoiding Harsh Hair Treatments: Individuals with CTE should avoid excessive heat styling, chemical treatments, or tight hairstyles that can cause additional stress on the hair and scalp. Being gentle with the hair by using mild shampoos and conditioners, avoiding excessive brushing, and limiting the use of heat styling tools can help reduce further hair loss.
  1. Time and Patience: In many cases, Chronic Telogen Effluvium resolves on its own once the underlying cause is addressed. Patience is key, as hair regrowth can take months, and improvements may be gradual. Consistent treatment and lifestyle changes will often yield positive results over time.

Prognosis

The prognosis for chronic telogen effluvium is generally positive, as it rarely leads to permanent hair loss. Once the underlying trigger is identified and treated, hair regrowth typically occurs within 6 to 12 months. However, some individuals may continue to experience intermittent shedding, particularly if the triggering factor is not fully resolved. Maintaining a healthy lifestyle, including proper nutrition and stress management, can significantly improve the chances of full recovery.

Chronic Telogen Effluvium is a prolonged and often frustrating condition, but with proper diagnosis and targeted treatment, it can be effectively managed. By addressing underlying causes such as nutritional deficiencies, hormonal imbalances, or stress, individuals can restore their hair health and prevent further shedding. Treatment requires patience and a holistic approach, but the prognosis is generally favorable, with most people experiencing noticeable improvement within a year.

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Door No. 8-2-293/82/A/725/A, Beside FMS INTERNATIONAL DENTAL CENTER Road No. 37, Hitech City Rd, near Daspalla Hotel, CBI Colony, Jubilee Hills, Hyderabad, Telangana 500033

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Jubilee Hills, Hyderabad, Telangana 500033

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