What are the causes of telogen effluvium?

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

Physiologic stress is the cause of telogen effluvium. These inciting factors can be organized into several categories, noted below. Evidence from mouse studies indicates that psychological stress can induce catagen, mainly by effects on neurotransmitters and hormones. [10] In humans, however, the role these effects play in hair loss has not yet been determined. While substance P has been extensively studies in human hair follicles in vitro, in vivo studies have not been performed. [11] In HIV disease, [12] apoptosis may be related to HIV-1 viral protein R. [13] Note the following causes:

  • Acute illness such as febrile illness, severe infection, major surgery, and severe trauma

  • Chronic illness such as malignancy, particularly lymphoproliferative malignancy; and any chronic debilitating illness, such as systemic lupus erythematosus, end-stage renal disease, or liver disease

  • Hormonal changes such as pregnancy and delivery (can affect both mother and child), hypothyroidism, and discontinuation of estrogen-containing medications [14] (see image below)

    Telogen effluvium secondary to hypothyroidism. Telogen effluvium secondary to hypothyroidism.
  • Changes in diet like crash dieting, anorexia, low protein intake, and chronic iron deficiency [15, 16, 17, 18] : A study by Olsen et al sought to determine if iron deficiency played a role in female pattern hair loss. Results indicated that iron deficiency is common in women but is not significantly increased in patients with female patterns of hair loss or chronic telogen effluvium when compared with control subjects. [19]

  • Heavy metals such as selenium, arsenic, and thallium

  • Medications, of which the most frequency cited are beta-blockers, anticoagulants, retinoids (including excess vitamin A), propylthiouracil (induces hypothyroidism), carbamazepine, and immunizations [20, 21, 22]

  • Psychological stress [18]


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