Chronic telogen effluvium

Chronic telogen effluvium is defined as excessive hair shedding lasting more than 9 months. Scalp sensitivity, burning and itching can also be present. In many cases it can last for a few years before resolving spontaneously. Hair density over the scalp vertex is not reduced, so the part line does not get wider. The typical patient is a female aged 30 to 50 years, with long hair. This condition commonly overlaps with female pattern hair loss (ie androgenetic alopecia).

Most cases of chronic telogen effluvium are idiopathic. The course of idiopathic cases can be longer than nonidiopathic cases and may continue indefinitely. Identifiable causes of chronic telogen effluvium include:

  • metabolic disorders (eg thyroid disease, severe liver or kidney impairment)
  • malnutrition (eg severe iron or zinc deficiency, hypoproteinaemia)
  • drugs (see Drugs that can be implicated in hair-loss disorders)
  • severe infections
  • connective tissue disorders
  • malignancy.

Most patients with chronic telogen effluvium are healthy and do not need extensive investigation. Only perform blood tests if indicated clinically—hair loss is usually not the only presentation of underlying causes. Possible tests include a full blood count, kidney and thyroid function tests, liver biochemistry, and antinuclear antibody (ANA) concentration.

Refer the patient for dermatologist advice if unsure of the diagnosis, and to exclude other conditions that cause significant hair shedding.

First-line treatment for chronic telogen effluvium is to correct identified triggers, if possible, and reassure the patient while waiting for the condition to resolve spontaneously.

Drug therapy is not usually required; however, if the patient is motivated, topical minoxidil can be trialled to hasten regrowth. See here for doses of topical minoxidil.

There is some evidence that iron supplementation in the setting of iron deficiency can reduce hair shedding in selected patients. Nutritional and collagen supplementation for hair loss in the absence of nutritional deficiency is not recommendedAdelman, 2021. The measurement of trace elements in blood and urine (eg serum ferritin, zinc, folate, vitamin B12, vitamin D) is not evidence-based practice.