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      Telogen effluvium: a comprehensive review

      review-article
      Author(s): 1
      Publication date (Electronic):
      Journal: Clinical, Cosmetic and Investigational Dermatology
      Publisher: Dove
      Keywords: telogen effluvium, hair, alopecia

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          Abstract

          Excessive hair shedding is a common and alarming phenomenon, usually complained about by women. The disorder, named telogen effluvium (TE), bears several problems which are discussed in this essay. They are as follows: 1) how profuse a hair loss must be for TE to be diagnosed; 2) its heterogeneity that needs to be properly classified; 3) its distinction from androgenetic alopecia (AGA) with which it is often associated; 4) its main symptom, trichodynia, which is unclear how frequent and how diagnostic could be; 5) why histopathology has been reported to be nonspecific; and 6) its management, from diagnosis to treatment. A common mistake of the dermatologist is to minimize the complaint. Instead, the disorder may have a profound impact on the patients’ mind and would require attention, time, and empathy.

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          Most cited references47

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          Stress inhibits hair growth in mice by induction of premature catagen development and deleterious perifollicular inflammatory events via neuropeptide substance P-dependent pathways.

          Petra Clara Arck, Bori Handjiski, Eva Milena J Peters … (2003)
          It has been much disputed whether or not stress can cause hair loss (telogen effluvium) in a clinically relevant manner. Despite the paramount psychosocial importance of hair in human society, this central, yet enigmatic and controversial problem of clinically applied stress research has not been systematically studied in appropriate animal models. We now show that psychoemotional stress indeed alters actual hair follicle (HF) cycling in vivo, ie, prematurely terminates the normal duration of active hair growth (anagen) in mice. Further, inflammatory events deleterious to the HF are present in the HF environment of stressed mice (perifollicular macrophage cluster, excessive mast cell activation). This provides the first solid pathophysiological mechanism for how stress may actually cause telogen effluvium, ie, by hair cycle manipulation and neuroimmunological events that combine to terminate anagen. Furthermore, we show that most of these hair growth-inhibitory effects of stress can be reproduced by the proteotypic stress-related neuropeptide substance P in nonstressed mice, and can be counteracted effectively by co-administration of a specific substance P receptor antagonist in stressed mice. This offers the first convincing rationale how stress-induced hair loss in men may be pharmacologically managed effectively.
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            Chronic telogen effluvium: increased scalp hair shedding in middle-aged women.

            David A Whiting (1996)
            Diffuse loss of scalp hair is a common problem in middle-aged women. A segment of these cases represents idiopathic chronic telogen effluvium (CTE). The purpose was to establish distinctive clinical and pathologic criteria for the diagnosis of CTE to facilitate its differentiation from androgenetic alopecia (AGA) and systemic causes of chronic diffuse hair loss. A group of 355 patients (346 females, 9 males) with diffuse generalized thinning of scalp hair of unknown origin were classified as having CTE and were included in the study. Characteristically they presented with a history of hair loss with both increased shedding and thinning of abrupt onset and fluctuating course and showed diffuse thinning of hair all over the scalp, frequently accompanied by bitemporal recession. Two 4 mm punch biopsy specimens were taken mostly from the mid or posterior parietal scalp of these patients. The biopsies were performed at these same areas in 412 patients with AGA (193 male, 219 female). Similar paired biopsy specimens were also taken from 22 normal control subjects (13 males, nine females). Specimens were sectioned horizontally and vertically and were examined for terminal and velluslike (miniaturized) hairs, follicular stelae, follicular units, and perifollicular inflammation and fibrosis. In horizontal sections of 4 mm punch biopsy specimens from patients with CTE the average number of hairs was 39, the terminal/velluslike hair ratio was 9:1, 89% of the terminal hairs were in anagen, and 11% were in telogen. In AGA these values were 35, 1.9:1, 83.2%, and 16.8%, respectively, and in normal control subjects 40, 7:1, 93.5%, and 6.5%, respectively. Significant degrees of inflammation and fibrosis were present in only 10% to 12% of cases of CTE and normal controls, but occurred in 37% of cases of AGA. CTE ran a prolonged and fluctuating course in many patients. CTE, which usually affects 30- to 60-year-old women, starts abruptly with or without a recognizable initiating factor. It may be distinguished from classic acute telogen effluvium by its long fluctuating course and from AGA by its clinical and histologic findings.
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              Telogen effluvium. New concepts and review.

              J T Headington (1993)
              Telogen effluvium is the result of a perturbation of the hair cycle that is manifest by increased loss of normal club hairs. Although diverse causes for telogen effluvium have been proposed, this article suggests several diverse mechanisms for the first time. Five different functional types of telogen effluvia are proposed based on changes in different phases of the follicular cycle. These are immediate anagen release, delayed anagen release, short anagen syndrome, immediate telogen release, and delayed telogen release. Diverse causes are confirmed and drug-related telogen effluvia are reviewed. The five diverse mechanisms proposed for telogen effluvia are generally confirmed and supported by clinical findings.
              Article 0 comments Cited 27 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Cosmet Investig Dermatol
                Journal ID (iso-abbrev): Clin Cosmet Investig Dermatol
                Journal ID (publisher-id): CCID
                Journal ID (pmc): ccid
                Title: Clinical, Cosmetic and Investigational Dermatology
                Publisher: Dove
                ISSN (Electronic): 1178-7015
                Publication date (Electronic): 21 August 2019
                Publication date Collection: 2019
                Volume: 12
                Pages: 583-590
                Affiliations
                [1 ]University of Genoa , Genoa, Italy
                Author notes
                Correspondence: Alfredo ReboraClinica Dermatologica , 7, Viale Benedetto XV, Genova16132, ItalyTel +3 901 0353 8417Email rebdermo@yahoo.it
                Article
                Publisher ID: 200471
                DOI: 10.2147/CCID.S200471
                PMC ID: 6709511
                PubMed ID: 31686886
                SO-VID: 8d858ac1-b1fb-49d8-8dba-5d5067db579c
                Copyright © © 2019 Rebora.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 07 February 2019
                Date accepted : 07 May 2019
                Page count
                References: 52, Pages: 8
                Categories
                Subject: Review

                ScienceOpen disciplines: Dermatology
                Keywords: telogen effluvium,hair,alopecia
                Data availability:
                ScienceOpen disciplines: Dermatology
                Keywords: telogen effluvium, hair, alopecia

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