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Acute telogen effluvium

It is the most frequent alopecia after androgenic alopecia. Hair loss is diffuse, reversible and more abrupt than in androgenic alopecia. It occurs 2 to 5 months after the triggering action has acted upon the telogen phase of the hair follicle.

It is a very common form of hair loss, especially in women. It consists on the sudden fall of a large number of hairs, which usually frightens the patient, who sees a lot of hairs on the brush when combing, in the drain after the shower or on the pillow after sleeping. It occurs because many follicles enter the phase of hair aging, known as telogen phase, which lasts 2-5 months until the loss begins to be noticed; they are also more fragile, so tend to fall more easily. The patient often notices that the hair is more fragile and detaches with greater ease, but a loss of hair density at the level of the scalp is not usually noticed.

Stimuli than may cause telogen effluvium:

  • Physical stress (such as illness, surgery, pregnancy...).
  • Drugs and hormones (hormonal contraceptives, anticoagulant drugs...)..
  • Acute infection and high fever.
  • Haemorrhage.
  • Emotional stress (loss of a family member, emotional problems).
  • Ultraviolet radiation.
  • Excessive hypocaloric diets
  • Stress related to study or work.

Due to these causes, a high number of hairs may enter telogen phase, starting to get loose within a few months. When it has occurred, the telogen effluvium usually generates great anxiety in patients, who see how each day they can lose more than 100 hairs, which produces a vicious circle of greater stress and hair loss.

It is very important to be aware that this type of alopecia is completely reversible. Every hair lost is replaced by a new hair, so that the total number of hairs remains stable. This means that the patient is not going to be completely bald within a few months, as many fear. Actually, the telogen effluvium can be considered an “acceleration” of the normal cycle of hair loss and birth.

With regard to treatment, the best approach is to identify the cause that may be producing the effluvium and act on it. In many cases, no other cause than work stress can be identified. In these cases, there is no more effective treatment than simply waiting, since the duration of telogen effluvium is usually limited to a few months.

Acute Telogen Effluvium

Clinical description

  • Large number of hairs on the comb, brush, pillow, etc.
  • It begins shortly after the causal aggression, at the latest after three months.
  • Massive indiscriminate loss after a stimulus, without area selection.
  • No relation to seborrheic constitution.
  • The analysis corresponds to the toxicity, dysproteinemia, endocrinopathy, etc.
  • Pulling out and trichogram with high percentage of hair in anagen or telogen phase.
  • It lasts until the cause is corrected.
  • Acute evolution and good prognosis.


Diagnosis is usually carried out based on clinical findings together with anamnesis and is often guided by the patient. An analytical study is sometimes recommended to identify the possible nutritional deficits or associated, not previously diagnosed, diseases.