Which physical findings suggest telogen effluvium?

Updated: Jun 13, 2018
  • Author: Elizabeth CW Hughes, MD; Chief Editor: Dirk M Elston, MD  more...
  • Print
Answer

The physical examination is the same in both acute and chronic telogen effluvium. Physical findings are sparse. Usually, the physician does not appreciate a decrease in hair density. However, if the patient's hair has been falling out for several months, the hair may appear thin when compared with old photographs.

Depending on the duration of hair loss, close examination of the scalp may reveal a higher than expected number of short new hairs growing. Because hair grows at a nearly constant rate of approximately 1 cm per month, the duration of the hair shedding can be estimated by measuring the length of the short hairs. Trichoscopy can be helpful in visualizing the hairs. [8]

In active telogen effluvium, the gentle hair-pull test yields at least two hairs with each pull. [9] If the patient's active shedding has ceased, the hair pull will be normal. Forced extraction of 10-20 hairs will yield a large percentage of telogen hairs. If greater than 25% of extracted hairs are in telogen, the diagnosis of telogen effluvium is confirmed.

There is one caveat to reliance on strict physical findings or numerical criteria in the diagnosis of telogen effluvium. Each patient's scalp hair has an individual characteristic growth cycle. There are patients who have a very long anagen phase and a small proportion of hair in telogen at any given time. These patients may experience an episode of telogen effluvium but have completely normal physical findings. History alone must guide the physician to the correct diagnosis in these cases.

There should be no areas of total alopecia in a patient with telogen effluvium. Scarring is not present. There also should be no sign of an inflammatory scalp dermatitis. Usually, there are no complaints of body hair loss.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!