The Localized Telogen Effluvium

Why does everyone say I have a localized telogen effluvium?

Too often, I hear patients tell me that they have been diagnosed with some kind of localized telogen effluvium. The story typically goes something like this:

I’m losing hair in the front and my doc thinks it’s a localized telogen effluvium 

I’m losing hair in the crown and I’ve been told it’s some kind of localized telogen effluvium.

By definition, a true telogen effluvium affects all hairs on the scalp equally. The hairs at the back feel the same pressure to leave as the hairs in the front. The hairs in the crown feel the same pressures to shed as do the hairs in the sides and back. So when someone tells me they are having a localized telogen effluvium, I know to look for another diagnosis. A localized telogen effluvium does exist. So it is not that the patient or doctor is way off in how they have come to that diagnosis. It’s simply that the main diagnosis is something else.

Here are a few examples:

1. When a patient with alopecia areata sees alot of hair coming out of one area of the scalp and someone confirms they seem to be telogen hairs that are being shed- the diagnosis is still alopecia areata. It’s true there is some kind if “localized telogen effluvium” going on - but the telogen hairs are being shed due to the alopecia areata.

2. When a patient with scarring alopecia sees alot of hair coming out of one area of the scalp and someone confirms they seem to be telogen hairs that are being shed- the diagnosis is still active scarring alopecia . It’s true there is some kind if “localized telogen effluvium” going on - but the telogen hairs are being shed due to the scarring alopecia.

3. When a patient with androgenetic alopecia sees alot of hair coming out of one area of the scalp and someone confirms they seem to be miniaturized telogen hairs that are being shed- the diagnosis is still androgenetic alopecia. It’s true there is some kind if “localized telogen effluvium” going on - but the telogen hairs are being shed due to the androgenetic alopecia.

Conclusion

A localized telogen effluvium should prompt the clinician and patient to search for an underlying diagnosis.