TELOGEN EFFLUVIUM: FROM THE FOLLICULAR CYCLE TO SCIENTIFIC RESEARCH
Professor Alfredo Rossi
Contents7 min read
The hair follicle undergoes a series of changes during its life cycle, which is divided into three key phases: anagen, catagen and telogen.
ANAGEN PHASE: THE HAIR GROWTH PHASE
The anagen phase is the growth phase and is the longest. Its duration varies from less than a month to over 7 years, depending on individual characteristics and anatomical location, and determines the maximum length the hair can reach.
Under physiological conditions, approximately 90 per cent of hair follicles are in the anagen phase. During this phase, the follicle is an extremely active organ in terms of mitosis and metabolism.
CATAGEN PHASE: THE TRANSITION
The catagen phase is a short phase of the follicular cycle, lasting 7–21 days.
During this transitional period, the follicle ceases mitotic activity and undergoes involution. Only 1 per cent of the follicles on the scalp are in this phase.
TELOGEN PHASE: THE RESTING PHASE
The telogen phase is the resting phase. On the scalp, it affects an average of 10 per cent of follicles and lasts for around three months. During this period, the follicle is ‘ready’ to begin a new cycle, re-entering the anagen phase and producing a new hair.
FROM THE FOLLICULAR CYCLE TO TELOGEN EFFLUVIUM
At certain times, exogenous or endogenous factors can slow down or halt the return of many hair follicles to the anagen phase. This leads to the condition known as telogen effluvium (TE).
WHAT IS TELOGEN EFFLUVIUM?
The term ‘Telogen Effluvium’ was introduced in 1961 by Kligman, who observed that stressful events, toxic, infectious or metabolic causes, and seasonal variations could alter the normal hair cycle, leading to sudden and massive hair loss during the telogen phase. Although it often resolves spontaneously, TE is a condition that can have a significant emotional impact and cause anxiety in those affected.
FORMS OF TELOGEN EFFLUVIUM: ACUTE AND CHRONIC
In acute TE, a stressful event causes the follicles to transition prematurely from the anagen phase to the telogen phase. In chronic TE, the cause may be less obvious and more protracted over time. This leads to a persistent disruption of the follicular cycle, with abnormal synchronisation of the follicles, which enter the telogen phase simultaneously.
WHAT IS TELOGEN EFFLUVIUM?
The term ‘Telogen Effluvium’ was introduced in 1961 by Kligman, who observed that stressful events, toxic, infectious or metabolic causes, and seasonal variations could alter the normal hair cycle, leading to sudden and massive hair loss during the telogen phase. Although it often resolves spontaneously, TE is a condition that can have a significant emotional impact and cause anxiety in those affected.
FORMS OF TELOGEN EFFLUVIUM: ACUTE AND CHRONIC
- Acute telogen effluvium consists of a marked and sudden loss of hair, lasting 2–3 months, regardless of the season, and which, in most cases, stops spontaneously with subsequent complete regrowth.
- Telogen effluvium is defined as chronic when hair loss persists for more than 6 months from the onset of the condition.
In acute TE, a stressful event causes the follicles to transition prematurely from the anagen phase to the telogen phase. In chronic TE, the cause may be less obvious and more protracted over time. This leads to a persistent disruption of the follicular cycle, with abnormal synchronisation of the follicles, which enter the telogen phase simultaneously.
FROM THEORY TO FORMULA: TURNING RESEARCH INTO A TARGETED INTERVENTION
Telogen effluvium can be triggered by a variety of conditions. The main triggers include:
MAIN DIAGNOSTIC FACTORS
The diagnosis is based on medical history, physical examination and specific tests. Among these, the modified Wash Test developed by Guarrera and colleagues enables the distinction between: pure telogen effluvium (TE), androgenetic alopecia (AGA), and mixed forms of TE + AGA. Trichoscopy is also a fundamental tool for assessing the rate of hair loss and differentiating TE from androgenetic alopecia.
- systemic or chronic diseases (autoimmune disorders, cancers, zinc deficiency)
- localised and systemic infections (high fever, syphilis, HIV, COVID-19)
- medications (retinoids, chemotherapeutic agents, antibiotics)
- physical stress (surgery, pregnancy, malnutrition)
- psychological stress
- hormonal imbalances (hypothyroidism, endocrine disorders)
MAIN DIAGNOSTIC FACTORS
The diagnosis is based on medical history, physical examination and specific tests. Among these, the modified Wash Test developed by Guarrera and colleagues enables the distinction between: pure telogen effluvium (TE), androgenetic alopecia (AGA), and mixed forms of TE + AGA. Trichoscopy is also a fundamental tool for assessing the rate of hair loss and differentiating TE from androgenetic alopecia.
CLINICAL MANIFESTATIONS OF TE
Telogen effluvium is characterised by:
TREATMENT OF TELOGEN EFFLUVIUM
In acute TE, resolution depends primarily on identifying and removing the triggering cause. Generally:
- diffuse hair loss across the entire scalp
- uniform thinning
- the presence, at the temples, of newly formed short, fine hairs
TREATMENT OF TELOGEN EFFLUVIUM
In acute TE, resolution depends primarily on identifying and removing the triggering cause. Generally:
- the condition resolves within three months,
- supplementation with amino acids, antioxidants, trace elements and vitamins may be beneficial,
- topical corticosteroids may be used in cases of trichodynia.
- specific supplements, topical treatments such as minoxidil and hydrocortisone butyrate.
TREATMENT OPTIONS FOR TELOGEN EFFLUVIUM
Treatment for TE leads, in the majority of cases, to complete hair regrowth. Chronic forms may persist, but they tend to stabilise if the underlying causes are identified and addressed, and the hair follicle is adequately supported metabolically.
As oxidative stress can interfere with the resumption of the follicular cycle, it is beneficial to support the hair follicle’s antioxidant mechanisms, which promote a return to the anagen phase.
As oxidative stress can interfere with the resumption of the follicular cycle, it is beneficial to support the hair follicle’s antioxidant mechanisms, which promote a return to the anagen phase.
CLINICAL STUDY: FIND OUT ABOUT THE METHODOLOGY AND RESULTS
PREVENTION AND SUPPORT FOR THE HAIR FOLLICLE
During an episode of telogen effluvium, to promote and accelerate regrowth, it is advisable to consider a targeted supplement containing:
THE ROLE OF ANTIOXIDANTS
Oxidative stress can interfere with the hair cycle. For this reason, it is important to use a combination of antioxidants capable of acting:
- amino acids
- vitamins
- trace elements
- antioxidants
THE ROLE OF ANTIOXIDANTS
Oxidative stress can interfere with the hair cycle. For this reason, it is important to use a combination of antioxidants capable of acting:
- both at the level of cell membranes,
- and on intracellular structures.
STRUCTURAL SUPPORT FOR HAIR FIBRES
To improve keratin formation and fibre strength, sulphur-containing amino acids and N-acetylcysteine help to supply sulphur ions, which are necessary for the formation of disulphide bonds that make the hair structure more robust.
Vitamins also play an essential role, supporting the follicle’s metabolic functions and increasing the energy available for vital cellular reactions.
The tested supplement has been shown to influence the course of telogen effluvium (TE), accelerating the return of follicles to the anagen phase and reducing recovery times.
The formulation is well suited to the metabolic needs of the hair follicle, as can be seen from the diagram above. Future prospects will depend on the possibility of making these substances more bioavailable so that they can reach the target in higher concentrations, thereby inducing the cell to perform better metabolically.
Vitamins also play an essential role, supporting the follicle’s metabolic functions and increasing the energy available for vital cellular reactions.
The tested supplement has been shown to influence the course of telogen effluvium (TE), accelerating the return of follicles to the anagen phase and reducing recovery times.
The formulation is well suited to the metabolic needs of the hair follicle, as can be seen from the diagram above. Future prospects will depend on the possibility of making these substances more bioavailable so that they can reach the target in higher concentrations, thereby inducing the cell to perform better metabolically.
