COVID-19 has definitely challenged our daily routines and social interactions and has placed stress on individuals, communities and nations. People often talk about stress and hair loss. So, with all this COVID-related stress, what kinds of hair loss might we see presenting to the dermatologist?

Telogen effluvium (TE) is a stress-related hair loss that we will explore here. The other type of hair loss that may be made worse by stress is the autoimmune condition called alopecia areata. We will explore this in a later blog.

1. What is telogen effluvium?
TE is the name given to temporary hair loss due to excessive shedding of the hair. Telogen effluvium can be classified acute (less than 6months) or chronic (more than 6months). The chronic form is more common in middle aged women. People with TE don’t lose all their hair but the hair will look thinner overall.

At any given time, about 90% of scalp hair is in the active, growing (anagen) and about 10% of hair is are in the resting (telogen) phase. It is in this telogen phase that hairs get shed. With TE, about 30% of the hair move into the shedding phase, meaning more hairs are shed on a daily basis.

2. What is the cause of telogen effluvium?
Stress or shock to the body can cause the hairs to move into the telogen phase. Examples of things that can trigger this include
• Psychological stress
• Childbirth
• Stopping the oral contraceptive pill
• Acute or chronic illnesses (especially those that cause fever)
• Surgery
• Significant weight loss
• Some hormonal conditions like an under- or over-functioning thyroid gland

3. What are the symptoms of telogen effluvium and what might you see?
People with TE describe excessive shedding of the hair (possibly for about 6-9 months) followed by a gradual reduction in the amount of hair shed on a daily basis. The shedding is noted about 3 months after the triggering event and hairs that fall have a small root at the end of it (called a club hair). As hair fall returns to the normal 100 hairs per day, the density of the scalp usually returns to normal.

Nails may also be affected in TE with a line through it called a Beau line. This occurs because stress can arrest the growth of the nail as well.

4. How is the diagnosis of telogen effluvium confirmed?
Usually this is diagnosis that can be made by taking a history and examining the scalp but if the problem has been going for over 6months, blood tests to exclude underlying medical issues will be needed. And a biopsy may be needed to differentiate it from alopecia areata that affects the entire scalp.

5. How can telogen effluvium be treated?
Telogen effluvium treatment is different for every person. The most important thing to do is to correct underlying medical issues (eg thyroid problems) if there are any and to ensure a wholesome, nutritious diet. Other helpful telogen effluvium treatment tips include careful handling of hair with gentle grooming and tension-free hair styles are also helpful.

The good news is that things usually return to normal after an episode of TE but if you feel your hair is thinner than it was before or if you are worried about the amount you are losing it is best to see your doctor/dermatologist for further information on telogen effluvium treatment options.

The information contained in this blog post is intended as a guide only and should not substitute seeking medical attention. Please see your healthcare provider for more information on suitability of products, treatments or procedures.

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