Telogen Effluvium in Patients with Darker Skin

00:01 Now let us talk about telogen effluvium.

00:06 This is diffuse, non-scarring hair loss, operative w ord, non-scarring hair loss that presents as a transient or chronic loss of hair.

00:18 There's very sparse epidemiological data on Telogen effluvium, but it is believed to be a common condition with no racial or ethnic differences in prevalence. It may be more common in women due to pregnancy and delivery.

00:34 So normally, if one examines the scalp, 5 to 10% of follicles are in the resting phase that is telogen.

00:42 Remember we spoke about the different phases: anagen, telogen and catagen.

00:51 And 90 to 95% of follicles are in growth phase that is active anagen.

00:56 This is what happens under normal circumstances.

00:59 However, intelligent effluvium different stressors e.g.

01:05 for example, acute or chronic major illnesses, childbirth, emotional stress, nutritional changes, certain medications and drugs.

01:15 This can lead to a certain number of anagen follicles switching to the telogen phase that is, the resting phase, so moving from the anagen phase to the telogen phase. The percentage of follicles in the telogen phase then increases up to 30%.

01:32 As new anagen hairs grow, they push out the telogen hairs.

01:38 2 to 4 months after the stressor, a patient may experience telogen effluvium or hair loss. Telogen effluvium clinically can present with acute or chronic reduction in scalp hair density. So the patient comes to you and tells you, doctor, I can see my scalp through my hair.

02:03 Typically, less than 50% of the scalp is lost.

02:08 And you may get typical diffuse distribution.

02:11 So it's not local, but it's all over the scalp.

02:15 Hair loss may be most noticeable in bitemporal bitemporal, frontal and vertex. So this phenomenon can also be observed in the nails, where one gets what you would call beau lines, which is these are grooves across the nail plate.

02:40 And this also happens if a patient has been ill or there's been a stressor.

02:46 Remember the nails and hair are keratin.

02:51 So acute telogen effluvium develops 2 to 3 months after the stressor.

02:58 However, hair growth usually is expected within 6 to 12 months.

03:04 If this becomes prolonged, then we call it chronic telogen effluvium.

03:11 And sometimes it's idiopathic, and it is when hair loss persists for more than 6 to 12 months. How do we diagnose Telogen Effluvium? On the history, we have to ask for possible triggers as mentioned before.

03:31 As well as do a hair pull test where we pull a number of hairs from the different areas of the scalp. And if you get more than two from each area, that means that you've got a positive hair pull test.

03:45 Trichoscopy can also be used, but it can be nonspecific.

03:51 The management of telogen effluvium is usually self-correcting.

03:55 However, removal or treatment of underlying cause may assist.

04:01 For example, treatment for associated illness, rectification of dietary deficiency.

04:09 Discontinuation of suspected drugs that may trigger telogen effluvium psychological support for those who are going through stress, and of course, oral minoxidil and topical minoxidil has also been used for telogen effluvium.