Telogen Effluvium

Under normal conditions, 85–90% of scalp follicles are in anagen. A systemic insult - surgery, high fever, crash diet, childbirth, severe emotional stress - causes a synchronised shift to telogen. When these resting hairs are released 8–12 weeks later, diffuse shedding of up to 400 hairs/day occurs (normal is ~100/day). The condition is usually self-limiting but can become chronic if the trigger persists.

Very common; spikes post-COVID infection and post-partum. Estimated to affect 1 in 5 women of reproductive age at some point.

• Diffuse thinning - no single bald patch
• Noticeably increased shed in shower, on pillow, or when brushing
• Hair part appears wider
• Onset typically 2–3 months after trigger event
• Scalp is normal (no inflammation, scaling, or tenderness)

• Childbirth (postpartum TE - most common form)
• COVID-19 or other severe illness with high fever
• Crash dieting or severe caloric restriction
• Major surgery under general anaesthesia
• Acute psychological stress
• Rapid weight loss (>10 kg in 3 months)
• Iron deficiency / ferritin < 30 ng/mL
• Thyroid dysfunction (hypo- or hyperthyroidism)
• Stopping combined oral contraceptive pill

• Hair pull test (positive if >10% of tested hairs release easily)
• Full blood count, serum ferritin, thyroid panel, Vitamin D
• Trichoscopy - increased telogen hairs, uniform shaft diameter (no miniaturisation)

Tests are performed by a qualified dermatologist or trichologist after clinical assessment.

Timeline: Acute TE typically self-resolves within 3–6 months once the trigger is removed. Full density recovery can take 9–12 months.

Consult a dermatologist if shedding exceeds 6 months, if you cannot identify a clear trigger, or if the hair pull test remains positive after 3 months of nutritional correction.