Telogen Effluvium (TE): Look for the Triggering Event (TE)

Look for the Triggering Event (TE)

Telogen effluvium (TE) is a hair shedding disorder whereby the affected individual notices increased daily hair loss. Minor TE’s might give a few more hairs in the sink or brush than one normally sees. A massive TE is associated with loss of hundreds and hundreds or hairs.

To fully understand telogen effluvium, one must understand the concept of the triggering event (TE). In other words, anytime a health care provider makes a diagnosis of TE they need to force themselves to think of what the triggering event (TE) or events might be. TE requires a search for the TE!

There are well over 2000 potential triggers of TE. At first it seems almost impossible to sort through all 2000 causes. Fortunatley, the most common triggering events can be classified in 7 big categories including

1) Low iron (ferritin) levels
2) Thyroid and other endocrine problems
3) Stressful life events
4) Poor diet
5) Weight loss and crash diets
6) Medications
7) Illnesses inside the body
8 Inflammatory scalp diseases like seborrheic dermatitis, lupus or psoriasis

This list is helpful as one sorts through potential triggering events. Unfortunately, in some cases one does not find the triggering event despite a methodical search through all these causes. One must in these cases either search deeper, ask more questions, order more tests or wait until the cause becomes apparent. Sometimes it never does which speaks to the limitations we have in the present day. 
Treatment of TE is centered entirely around trying to deal with the triggering event. If iron levels were low, they must be replenished. If a thyroid problem was identified, it must be addressed. If the patient’s diet is poor, it must be improved. 
In cases where we can’t find a trigger sometimes the shedding resolves on its own after some extended period of time. In other cases, treatment with non specific agents like minoxidil or laser helps reduce shedding and helps the hair stay “better glued” to the scalp.