The patient is a 63-year-old Hispanic woman who complains of the abrupt onset of hair loss, first noted 6 weeks ago. Baseline laboratory studies ordered by her internist, including complete blood count, thyroid-stimulating hormone, serum iron, and antinuclear antibody panel, were unremarkable. Relevant medical history includes cardiac surgery performed 6 months ago. She is currently on multiple medications, including a beta-blocker. Examination reveals diffuse thinning without evidence of scarring.
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Telogen effluvium (TE) is characterized by a relatively sudden onset of nonscarring, noninflammatory alopecia. TE is the most common cause of diffuse scalp hair loss and results from an accelerated premature shift in anagen, or the growth phase, to catagen (involution phase) and telogen (resting phase).1
TE is a reaction pattern linked to a number of stressors that include pregnancy, nutritional deficiency, febrile states, rapid weight loss, and surgery.2 Drugs, including beta-blockers, have also been implicated. The diffuse loss of telogen hairs will be seen 3 to 4 months after the triggering event. Patients typically present with the abrupt onset of diffuse generalized shedding of hairs and may lose hundreds of hairs per day. Hair pull test will be strongly positive with 10% or more of the hairs pulled being easily extracted.3 Diagnosis is based on history, clinical findings, hair pull test, and uncommonly biopsy to exclude other causes.1 No treatment is necessary as the disease process is usually self-limiting.3 If the precipitating factor is removed or corrected, complete regrowth is expected, although hair density may take a year to return to baseline.4
Dr Schleicher is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at the Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College. Lauren Ax is a physician assistant student at Kings College in Wilkes Barre, PA.
- Wolff K, Johnson R, Saavedra A. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. 7th ed. New York: McGraw-Hill; 2013.
- Shashikant M. Telogen effluvium: a review. J Clin Diagn Res. 2015;9:WE01-WE03.
- Shrivastava SB. Diffuse hair loss in adult female: approach to diagnosis and management. Indian J Dermatol Venereol Leprol. 2009;75:20-28.
- Phillips TG, Slomiany WP, Allison R. Hair loss: common causes and treatment. Am Fam Physician. 2017;96:371-378.