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
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.
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.
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 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.
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.
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.
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.
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.
Triggers and Management of Diffuse Hair Loss
Diffuse hair loss can affect anybody regardless of age and gender. There is a number of triggers including nutritional deficiencies, a variety of physiologic or emotional stresses and endocrine imbalances. Hair loss at telogen phase is the most common type of diffuse hair loss. Hair loss can also occur during the anagen phase, typically due to chemotherapy or radiation therapy. Diffuse hair loss can be distressful. Usually patients notice an increase in the number of hairs in the shower drain or on the pillow.
There are cycles in the growth of scalp hair. Each hair follicle goes through 10 to 30 cycles in its lifetime. There are different phases in hair cycles. First phase is anagen phase or active hair growth phase. Second phase is catagen phase and the third phase is telogen or resting phase. Duration of anagen phase can be 2 to 8 years. Duration of catagen phase can be 4 to 6 weeks. Duration of telogen phase can be 2 to 3 months. There is another phase, which is exogen phase during which release of dead hair happens. This phase coincides with the end of the telogen phase. Disruption in anagen phase can result in diffuse hair loss. Telogen effluvium is the most common type of diffuse hair loss. It involves anagen-phase hair follicles prematurely transitioning to the telogen phase, leading to increased hair loss at the end of the telogen phase. It takes a thorough examination to find the triggers of diffuse hair loss
Triggers of diffuse telogen hair shedding
Diffuse hair loss can get triggered by physiologic stresses such as surgical trauma, high fever, chronic systemic illness, hemorrhage, etc. Diffuse hair loss can also occur few months after childbirth.
There may be a link between diffuse hair loss and emotional stress. It is difficult to ascertain the link. Hair loss itself is a reason for stress. Historically, acute reversible hair loss has been reported in relation to great stress. Nonetheless, the association between psychological stress and chronic diffuse hair loss remains confusing and controversial. Evidence to back up such association turns out to be weak, as everyday stresses are unlikely to be serious enough to cause hair loss.
Both hyperthyroidism and hypothyroidism can lead to diffuse telogen hair loss. Such hair loss is reversible when the euthyroid state is restored. Diffuse telogen hair loss can get caused by chronic systemic disorders like hepatic failure, systemic amyloidosis, inflammatory bowel disease, chronic renal failure, lymphoproliferative disorder, etc. Diffuse telogen hair loss has also been reported in relation to autoimmune diseases such as dermatomyositis and systemic lupus erythematosus, as well as chronic infections like secondary syphilis and human immunodeficiency virus type 19. Inflammatory disorders like seborrheic dermatitis, psoriasis and allergic contact dermatitis can trigger diffuse telogen hair loss.
Nutritional deficiency like iron and zinc deficiency can cause diffuse telogen hair loss. Severe fatty acid, protein and caloric restriction with chronic starvation and crash dieting can trigger diffuse telogen hair loss. Pancreatic disease and malabsorption syndromes can precipitate diffuse telogen hair shedding. Vitamin D plays an important role in cell growth. Diffuse hair shedding can be linked with vitamin D deficiency.
Diffuse telogen hair loss can get triggered by certain drugs, usually twelve weeks after starting the drugs. Changes in dosing can precipitate hair loss. Any medication should be suspected in hair shedding. Drugs that can cause diffuse telogen hair loss include oral contraceptive pills, retinoid, androgens, beta-blockers, anticonvulsants, angiotensin-converting enzyme inhibitors, antidepressants, anticoagulants heparin, warfarin, etc. Stopping or changing contraceptive of any type can precipitate diffuse telogen hair shedding. Hormonal replacement therapy along with high-dose of progesterone and oral contraceptives containing androgenic progestin can trigger diffuse telogen hair shedding with or without patterned alopecia.
Management of Diffuse Hair Loss
Being mindful of potential triggers, consulting a hair specialist and having proper diagnosis is important. Education about the natural history of the condition is the most important aspect in managing telogen effluvium. The normal hair cycle as well as relationship between triggers and the timing of hair loss need to be understood. For instance, diffuse hair loss can occur 2 to 3 months after a cause occurs
Maintaining a health diary or calendar can be useful in identifying triggers. The patient can keep record of any stress, hospital admission, new medications, surgical procedure, dosage changes in medications, etc. The patient needs to understand that once the cause gets identified and treated, the hair loss can settle, but can still continue for up to 6 months. 3 to 6 months after the cause has been taken care of, regrowth can occur, but it can take 12 to 18 months for cosmetically significant regrowth to occur. In case of acute telogen effluvium, the shedding short-lives if the cause can be identified and treated. Further treatment is usually not required. Patients in such cases are very unlikely to go bald.
Adequate nutrition intake is essential. In case a drug is suspected, it should be stopped for at least 3 months to assess whether or not it is a contributing factor. Anti-dandruff shampoo and a topical corticosteroid can help treat any underlying scalp inflammation like serorrheic dermatitis or psoriasis. Chronic diffuse telogen hair shedding is more complex as multiple or repetitive triggers can be involved. Thyroid disease, nutritional deficiencies, infections and systemic illness should be treated properly. Biotin and zinc replacement can enhance hair regrowth in case of chronic-repetitive telogen effluvium, chronic diffuse telogen hair loss and acute telogen effluvium.
Specific medical treatment for telogen effluvium does not exist. However, applying the topical hair-growth promoter minoxidil (2% and 5%) can be useful in case of chronic diffuse telogen hair loss and chronic telogen effluvium. For any type of diffuse of hair loss, treatment should be done in consultation with a specialist as well as relevant recommendation made by the US Food and Drug Administration.
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