Hair is a visible reflection of internal health. When physiological balance is disrupted, one of the most common manifestations is diffuse hair loss, often associated with telogen effluvium, an alteration in the hair growth cycle. When this process extends beyond the usual time frame, it is referred to as chronic telogen effluvium.
Chronic telogen effluvium is a persistent form of hair loss that occurs when a large number of hair follicles prematurely enter the telogen phase (the resting phase of the hair cycle), leading to excessive and diffuse hair shedding across the entire scalp.
Unlike acute telogen effluvium, which typically lasts between 2 and 4 months and resolves on its own after the triggering cause ceases, chronic telogen effluvium remains active for more than 6 months, sometimes for years, with cyclic episodes of intense shedding and partial recovery.
This condition does not cause localized bald patches or leave areas without hair but results in a decrease in hair volume and significant emotional impact on those affected.
Although it can affect both sexes, chronic telogen effluvium is more common in adult women, especially between the ages of 30 and 60. A high incidence has been observed in women with a history of anemia, hypothyroidism, polycystic ovary syndrome, and those who have experienced prolonged periods of stress or have been exposed to intense hormonal changes, such as postpartum or discontinuation of contraceptives.
Among the most common triggering factors of stress-induced chronic telogen effluvium are:
Prolonged physical or emotional stress
Low-calorie diets or nutritional deficiencies
Autoimmune or infectious diseases
Major surgeries or significant trauma
Prolonged use of medications such as retinoids, antidepressants, or anticoagulants
In many cases, no clear trigger is identified, making diagnosis challenging and causing uncertainty for the patient.
The duration of chronic telogen effluvium can vary significantly from person to person. In some cases, it presents with periodic flare-ups that can last several months or even years, with phases of partial improvement followed by relapses.
Although shedding usually stabilizes, in the absence of appropriate treatment, it can persist over time and compromise long-term hair volume.
A common question is: Is chronic telogen effluvium curable?
The answer is that yes, chronic telogen effluvium is reversible in most cases. It is not a form of scarring alopecia, so the follicles are not destroyed but inactive. With an appropriate approach, recovery from telogen effluvium can be achieved progressively.
Treatment of chronic telogen effluvium should be comprehensive and tailored to the specific cause. There is no single universal solution, but a multidisciplinary approach involving dermatology, internal medicine, and clinical pharmacy has proven to be highly effective.
It is essential to perform:
Complete blood work including iron, ferritin, zinc, vitamins D and B12, TSH, and sex hormones.
Digital trichoscopy to analyze the shedding pattern and rule out other types of alopecia such as androgenetic or areata.
Comprehensive medical history to detect hidden or multifactorial causes.
Specific supplementation can aid in recovery from telogen effluvium:
Iron (if ferritin < 70 ng/mL)
Vitamin D
Biotin and B-complex vitamins
Zinc and antioxidants
Sulfur-containing amino acids such as cystine
These nutrients help stimulate the anagen phase (growth phase) of the hair cycle, promoting stronger, healthier regrowth.
In cases of chronic telogen effluvium caused by stress, medical treatment should be supported with emotional well-being strategies, such as:
Psychological therapy or mindfulness practices
Regular physical activity
Improving sleep quality and reducing fatigue
Chronic emotional stress is a common factor that can prolong or worsen hair shedding, so managing it effectively is crucial to recovery.
Depending on the cause and the individual profile, the following therapies may be recommended:
Topical minoxidil to reactivate dormant follicles and prolong the growth phase
Hair mesotherapy with vitamins, peptides, and amino acids
Systemic antioxidants such as resveratrol or coenzyme Q10
Platelet-Rich Plasma (PRP) therapy to regenerate weakened hair roots
In some cases, if chronic telogen effluvium is associated with androgenetic alopecia, anti-androgen medications such as finasteride or dutasteride may be prescribed, especially in male patients, under the supervision of a specialist.
Chronic telogen effluvium is treatable when approached with the right tools: early diagnosis, a multidisciplinary medical plan, and consistent follow-up. It does not lead to permanent baldness, and the hair follicles remain intact, only inactive.
With the proper treatment protocol, hair regrowth after chronic telogen effluvium is achievable in most patients. Personalized care and addressing underlying causes—whether nutritional, hormonal, or emotional—are key to regaining hair volume and restoring patient confidence.