What is diffuse hair loss?


Diffuse hair loss is also known as chronic Telogen Effluvium. It can affect both men and women at any age. It causes hair fall and subsequent thinning of hair from all over the scalp. Whilst the hair gets thinner, follicles remain. Interruption in the normal hair cycle can cause diffuse hair loss. Diffuse hair loss is distressful. It becomes noticeable as it causes increase in hair in the shower drain or on the pillow or while brushing. Usually, women can notice it better than men.


When most of the hair falls out and most of the hair go into dormant, state it is called diffuse hair loss. When it happens hair starts falling sporadically. Although hair falls but there is no loss of follicles. In the beginning, it is difficult to be sure whether it is diffuse hair loss or not. For this, your doctor will need clinical history. While your diffuse hair loss is being treated the under lying cause must be fixed.


The Normal Hair Cycle


There are cycles in the growth of scalp hair. Disturbance in one phase of the hair cycle can result in diffuse hair loss. Phases of a hair cycle include anagen, catagen and telogen. The anagen phase is about active growth and lasts 2 to 8 years. The catagen phase is about involution and lasts 4 to 6 weeks. The telogen phase is about resting and last 2 to 3 months. End of the telogen phase coincides with the exogen phase, which is about release of dead hair.


Typically, hair follicle cycles independently, which allows some hairs growing while others are shedding or resting. People usually have 100000 scalp hairs. 10% to 15% of the hairs are normally in telogen phase. Loss of 100 to 150 telogen hairs every day is considered normal. However, anagen hair loss is considered abnormal. Telogen effluvium is the most common type of diffuse hair loss, in which anagen-phase hair follicles get onto telogen phase prematurely.


Signs of Diffuse Hair Loss


When diffuse hair loss happens you will lose hair evenly all over the scalp. Your scalp hair will be thinner day-by-day. Telogen effluvium is temporary situation but when it becomes chronic it last for long time near about for six months. Diffuse hair loss is mostly seen to women but some men also can be affected.


What causes diffuse hair loss?


Diffuse hair loss is caused due to multiple reason. The reasons are given below


Physical stress

Serious physical or mental stress can cause hair loss. Besides, if you are affected with chronic health disease like typhoid, chronic trauma, malaria etc. then you will lose hair extremely.


Hormonal factors

Hormone plays a vital role in hair loss. Hyperthyroidism, polycystic ovarian diseases, birth control pills, poor diets causes hair loss. Hormonal imbalance can be identified for hair loss if you notice any change in menstrual cycle, weight gain, and pimple on your face. It is very common to have diffuse hair loss after delivery of baby. It happens within 6 months and is cured within 3-6 months.


Dietary deficiencies

Diet is very important for any kind of health issues. When you eat less amount of food intake your body goes through a complex changes particularly when you don’t include protein, vitamins, minerals, iron and zinc etc. hair loss is normal for those who follow crash dieting or don’t take minimum amount of calories due to eating fast food.



Some drugs that are used for high blood pressure, psychiatric diseases, thyroid disorders, hormonal imbalance cause hair fall. When you are having any of these drugs ask your doctor for prescribing alternative medicine.



Sometimes hair falls but the exact reason cannot be identified. This is very common to female whose age is between 30-60.  


The Differential Diagnosis of Diffuse Hair Loss


Telogen Hair Loss


There are different triggers for telogen effluvium. Types of telogen hair loss get determined by the triggers involved. When telogen effluvium is acute, it lasts less than 6 months. When it is chronic, it lasts 6 months or longer. Telogen effluvium can also be chronic-repetitive.

In case a trigger short-lives, the telogen effluvium will likely resolve. Telogen hair loss can go on when a trigger happens repeatedly or a trigger is not reversed.


Anagen Hair Loss


Premature end of anagen hair growth or anagen arrest causes anagen hair loss. Usually, it is caused by treatment with radiation or cytotoxic drugs.


Triggers of Telogen Hair Loss


Numerous triggers can be responsible for telogen effluvium. Following are some of the potential triggers.


Physiologic Stress


Physiologic stress such as high fever, surgical trauma, hemorrhage and chronic systemic illness are well known to be responsible for telogen effluvium. Telogen hair loss can also happen few months after childbirth.


Emotional Stress


Link between hair loss and emotional stress is hard to determine, as hair loss itself is distressful to patients. There has been report regarding link between great stress and acute reversible hair loss. However, link between psychological stress and chronic diffuse hair loss is controversial. Evidence regarding such link appears to be weak. Everyday stresses are not serious enough to trigger hair loss.


Medical Conditions


Both hyperthyroidism and hypothyroidism can cause diffuse hair loss, which can be reversed by restoring euthyroid state. Chronic systemic disorders such as hepatic failure, systemic amyloidosis, inflammatory bowel disease, chronic renal failure and lymphoproliferative disorders can cause telogen hair loss. Autoimmune diseases such as dermatomyositis and lupus erythematosus are also linked with telogen hair loss. Chronic infections such as secondary syphilis and human immunodeficiency virus type 1 can be associated with telogen hair loss. Inflammatory disorders such as seborrheic dermatitis, allergic contact dermatitis and psoriasis can cause telogen hair loss.


Dietary Triggers


Iron and zinc deficiency can cause diffuse telogen hair loss. Severe fatty acid, calorie and protein restriction along with crash dieting or chronic starvation can also stimulate diffuse telogen hair loss. Pancreatic disease and malabsorption can precipitate telogen hair loss. Telogen hair loss can be linked with essential fatty acid deficiency. Vitamin D contributes to cell growth. Diffuse hair loss may also be linked with vitamin D deficiency.


Drugs causing Hair Loss


Drugs that can cause telogen effluvium include oral contraceptive pills, retinoid, androgens, anticonvulsants, angiotensin-converting enzyme inhibitors, beta-blockers, antidepressants, anticoagulants heparin and warfarin. Stopping or changing oral contraceptive can precipitate telogen hair loss. Oral contraceptives that contain hormonal replacement therapy with high-dose progesterone and androgenic progestin can cause telogen hair loss. Telogen hair loss begins 12 weeks after use and persists in relation to continuation of drug.


Physical Examination


As diagnosis of diffuse hair loss is complex, clinical examination is highly useful. The scalp is subject to examination in determining pattern and degree of hair loss. The hair shafts can be examined to check on diameter, length and breakage. The scalp can be assessed for erythema, scaling and inflammation.  


Hair loss patients should do hair-pull test. Light-microscopy can help draw distinction between dystrophic anagen hairs and telogen hairs. Nutritional deficiencies can also get indicated by hair shaft microscopy. Sometimes, it is useful to have daily count of hair loss. Loss of more than 100 hairs everyday suggests effluvium. Hairs can then be tested to be recognized as anagen or telogen hairs.


Laboratory Evaluation and Scalp Biopsy


Causes or triggers of diffuse telogen hair loss can be identified by laboratory workup. Laboratory workup involves blood count and serum ferritin level to check on iron deficiency and anemia. It monitors thyroxine and thyroid-stimulating hormone to detect thyroid disease. It monitors serum zinc level to check on zinc deficiency.


Chronic hair loss, miniaturized hair shafts, lack of identifiable triggers etc. necessitates scalp biopsy. In most cases of hair loss, scalp biopsy is useful.              


Diffuse Hair Loss and Importance of Patient Education


Managing telogen effluvium essentially requires patient’s education on natural history of the condition. Patients need to understand hair cycle, as well as the relationship between the timing of hair loss and triggers. For example, telogen effluvium can begin 2 to 3 months after a trigger occurs.


Using a calendar or diary can be helpful in identifying triggers. Patients can keep record of potential triggers such as surgical procedures, hospital admissions, stresses, dosage changes etc. Patients should understand that after any trigger is spotted and treated, hair shedding might persist for up to six months. Re-growth can happen about 6 months after the trigger has been treated.


In case of acute telogen effluvium, once the trigger is taken care of, the shedding does not continue for long and further treatment is not necessary. In such case, patients are unlikely to go bald.


It is important to address nutritional deficiency. A drug that is suspected to be linked should be discontinued for at least three months. This can help determine whether the drug was linked. A tropical corticosteroid or an anti-dandruff shampoo should be used to treat any underlying scalp inflammation such as psoriasis or seborrheic dermatitis.


Infections, systemic illnesses, thyroid disease and nutritional deficiencies should be treated as repetitive or multiple triggers make chronic diffuse hair loss complex. Zinc and biotin replacement can aid hair re-growth in cases of chronic-repetitive telogen effluvium, chronic diffuse telogen hair loss and acute telogen effluvium.


There is hardly any particular treatment for telogen effluvium. However, in cases of chronic telogen effluvium and chronic diffuse telogen hair loss, application of minoxidil can be useful, which is a tropical hair-growth promoter.


As diffuse hair loss is not very simple to deal with, exploring the issue at length can be helpful. On top of being self-educated, seeking professional advice is especially useful in dealing with the issue.


Woman are very concern with their look and diffuse hair loss mostly damages their look. Therefore, they feel inferiority due to extreme hair fall. So it is necessary to be mentally strong otherwise the situation can be deteriorated.


More on Hair Loss Cause: 


1. Can Estrogen Cause Hair Loss?

2. Can Hairspray Damage Your Hair?

3. What is The Cause of Patchy Hair Loss?

4. What is DHT Hair Loss?

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