Acute telogen Effluvium

A sudden dramatic increase in hair shedding is seen in acute telogen effluvium

Acute telogen effluvium is the most common cause of sudden hair loss in women. Women with this pattern suddenly start losing hair from the entire scalp and a lot of it. There is nothing subtle or gradual about this and it usually has a definite starting point. Most women with acute telogen effluvium experience a spontaneous recovery even without treatment but it takes 6 to 9 months. Even while the hair loss continues, if they look closely they can see a multitude of new short replacement hairs growing out of the scalp. This is a good sign that usually means recovery has begun and one that differentiates the chronic form of telogen effluvium from the more common acute form.

The cause of acute telogen effluvium

The cause of hair loss in acute telogen effluvium is a triggering of a widespread synchronized resetting of the natural hair cycle. The normal growth phase called anagen to the death phase called catagen. The “father” of this cause is the inciting event pulls this trigger causing the termination of anagen and the initiation of catagen.

After death, the hair shaft cycles into the third and final phase called telogen. In telogen, there is no remaining living hair shaft bud as it died in the catagen phase of the cycle. This causes the dead shaft to become disconnected from the base of the living hair follicle. The dead hair shaft remains within the follicle for a while because it is deeply wedged in and has sticky sides; factors that keep it in place.

Telogen lasts about 3 months on average. The dead hair in telogen can be pulled out of the follicle at any time by brushing or pulling on the hair. Any dead hair shafts remaining are finally expelled when the follicle renters the growth anagen phase of the cycle and a new hair is formed. The new hair pushes the dead hair out of the follicle as it grows up it. This causes natural shedding of the dead hair.

Treatment of acute telogen effluvium

Traditionally we tell women and teach medical students that no treatment is needed for acute telogen effluvium because the hair loss will eventually stop and recover on its own. While this is true for most it is not so for some. The problem is we cannot distinguish who with this hair loss pattern will recover spontaneously and who will not. The minority of women with progressive hair loss then are reclassified as having chronic telogen effluvium but not until late in the course of this disorder.

It is not impossible to predict who with acute telogen effluvium will experience chronic hair loss and who won’t. So with the exception of management of women with hair loss due to chemotherapy we do not recommend special precautions or any treatment. Simply put it is not worth worrying about because it is almost certainly not going to happen to you despite experiencing one of the known trigger events.