Written by Dr. Sanjana V.B Bhms,dbrm,cdn

Founder & medical director of siahmsr wellness.in

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Reviewed by SIAHMSR medical team

Telogen effluvium- homeopathic hair loss treatment

Overview

    Telogen effluvium[ TE] is a common form of hair loss happening shortly after a major physical or mental stress such as a prolonged illness, major surgery or serious infection etc.

  Stress is one of the major contributing factors for telogen effluvium hair loss. Other causes include sudden weight loss, surgery, pregnancy & child birth, menopause, intake of certain medications etc.

Erratic diet and nutritional deficiency resulting from it is one of the major causes of telogen effluvium type of hair loss. Studies have also shown  strong association between nutritional deficiency and chronic Telogen Effluvium hair loss.

    Telogen effluvium[TE] is one of the most common causes of diffuse hair loss, although it is temporary. Telogen effluvium was first described by Kligman in 1961.

Numerous triggers have been implicated in this type of hair loss. TE is a non-scarring, diffuse, hair loss from the scalp that occurs around 3 months after a triggering event and is usually self-limiting, lasting for about 6 month. In TE hair loss is usually less than 50% of the scalp hair. 

To understand telogen effluvium  comprehensively one must know about hair cycle.

Hair cycle

Hair cycle includes sequential phases of growth and rest that each hair follicle goes through ,such as

1. anagen (active hair growth)

2. catagen (involution) 

3. telogen (resting) 

4. exogen [release of telogen hair] .

   The anagen phase may last for about 2 to 8 years, the catagen phase lasts for 4 to 6 weeks and the telogen phase lasts for 2 to 3 months. The exogen phase of hair follicle (the release of telogen hair) meets with the end of telogen phase.

 In the normal scalp, 90–95% of the hair follicles are in the anagen phase and the remainder (5–10%) in the telogen phase. Only a few follicles will be in the transitional or catagen phase. 

About 100-150 hair being shed daily. It is quite normal to lose this much amount of hair daily.

      In telogen effluvium a temporary alopecia or baldness like hair loss occurs as the long telogen hairs are replaced by the shorter new anagen hair. Hair loss resolves as the new anagen hair grow in 3-6 months if no repetitive injury to hair from triggering factors.

   After childbirth hair loss is common in mothers. In this  post-partum telogen effluvium or hair loss after childbirth, follicles remain in prolonged anagen phase rather than transiting into telogen phase. Later it is  finally released from anagen, with increased shedding of hair in telogen phase.

Classification telogen effluvium hair loss

There are five functional types of telogen effluvium which are as follows:

1 Immediate anagen release:

 It is a common form of telogen effluvium type hair loss which follows physiological stress to your body ,such as high episodes of fever. Fever causes death of hair follicle cells.

During fever, the cytokines [ inflammatory markers]  cause cellular death of hair follicle keratinocytes. So hair cycle now starting with catagen then followed by telogen . Thus hair loss soon after fever happens.

2.Delayed anagen release:

 This type of TE hair loss  typically occurs after childbirth in women. That is known as post-partum hair loss. It is also termed as telogen gravidarum. The main cause is sudden hormonal dip in women after childbirth.

 During pregnancy high level of circulating placental estrogen prolongs anagen phase of hair and leads to good hair growth during pregnancy. The growing hair is anagen hair. The anagen phase is prolonged under hormonal influence during pregnancy. It last during pregnancy period. But sudden  withdrawal of these pregnancy maintaining  hormones after childbirth causes all the overdue anagen hair to enter into catagen phase simultaneously. This leads to increased shedding of telogen hair.

Hair loss of this kind is seen after few months of delivery.

3. Immediate telogen release:

Hair follicles are normally programmed for release of the club hair after a normal interval of 100 days. This results from a shortening of the normal telogen cycle.

This type of hair shedding usually occurs 2-8 weeks after initiation of hair therapy with topical minoxidil [medicine application on hair] . This is because, with the anagen phase being stimulated, there is release of the exogen hair which were in resting phase. Nothing to worry. Hair growth will happen after this  short episode.

4. Delayed telogen release:

In this type, hair follicles remain in prolonged telogen phase rather than being shed and recycling into anagen phase. Termination of telogen phase with hair shedding sets in. This process is seen in seasonal shedding of hair in humans or in hair loss following travel from low-daylight to high-daylight environment.

5. Short anagen phase:

 It is characterized by the inability to grow long hair. Here anagen phase is very short. This condition is not due to hair shaft fragility or hair unruliness as believed often. It occurs in some genetic diseases [hereditary hypotrichosis, ectodermal dysplasia] and as an isolated disorder in otherwise healthy children.

Signs & symptoms of TE hair loss

   ·    Hair loss occurs diffusely from the scalp approximately 2-3 months after the triggering event.

   ·    The diffuse loss may produce thinning of hair all over the scalp, but frequently manifest with bitemporal recession or hair receding from both sides of forehead.

       Normally more than 50% of the scalp hair is not lost  in telogen effluvium

   ·   Scarring and inflammation are absent in this type of hair loss.

   ·   Clumps of hair can be extracted with ease from top of head as well as the margins of the scalp

Chronic telogen effluvium (CTE)

   CTE is a type of diffuse hair loss of scalp that persist for more than six months. It is characterized by sudden, excessive, diffuse shedding of hair that continues with a fluctuating course over several years.

This condition chiefly affects women of age group 40-50 years. It may happen from various causes.

Tests or investigations 

 Detailed history and clinical examination helps to detect the causes of telogen effluvium hair loss.

Testing is not necessary often. However following tests are available.

·        The hair pull test is strongly positive in TE. It is done by grasping 40-60 closely grouped scalp hair with thumb and index finger and gentle traction is applied as the hair are pulled firmly and slowly from the scalp. Normally only 2-3 hair are pulled out by this method.

·        The trichogram (hair pluck test) from a hair pluck sample is abnormal and shows greater than 25% telogen hair   

   Laboratory  tests:

  Complete blood count, urine analysis, serum ferritin and T3, T4, thyroid stimulating hormone (TSH)  are ordered to rule out other causes

Treatment

*    Counselling:

 Counseling  about the nature of this type of hair loss may help to reduce the stress. Normal hair cycle and relationship between triggers and timing of hair loss may be explained by the health care provider or trichologist [ hair specialist] . The reversibility of TE hair loss will be explained along with some assurance and directions to be followed.

   Counselling &mind relaxation techniques to reduce stress such as yoga ,pranayama, mindful walking etc. are helpful.

*    Dietary changes or nutritional intervention:

Include some nutrient rich foods in your diet such as:

·  Omega fatty acids

Omega 3 fatty acids play an important role in cell structure, barrier function, lipid synthesis, inflammation and immunity. They help in reducing dryness of scalp skin. Most popular sources  of omega fatty acids are walnuts, fish oil, flaxseed oil etc. These are vital nutrients that support the health of hair follicles. Whenever the follicle health is compromised, hair loss or thinning occurs.

Minerals       

It has been found that certain minerals including magnesium, sulfur, silica and zinc are also very important toward maintaining healthy hair.

·   iron

     Iron deficiency is one of the common causes of hair loss. Low iron stores with  decreased serum ferritin is common in patients with chronic Telogen effluvium.

In severe cases iron supplements are recommended with withdrawal at a specified interval. Prolonged iron intake is not good for the body.

The natural sources of iron are green leafy vegetables like spinach, kale, collard etc.

Vitamin C intake is crucial in patients with hair loss associated with iron deficiency as it plays an essential role in the intestinal absorption of iron.

·  Selenium

 Selenium is an essential trace element that plays a role in protection from oxidative damage as well as hair follicle morphogenesis. Include more sea foods and nuts in your diet.

·  Zinc

  Zinc is very important for hair growth. Deficiency of zinc can occur with poor intake, in some diseases like cancers, liver or renal dysfunction, in pregnant women, and patients with alcoholism.

Some medications that can affect zinc levels include valproic acid and certain anti-hypertensive drugs. Drug related and diseases related deficiencies need to be rectified only after consulting your health care provider or doctor.

Dietary inclusion of zinc is recommended through intake of meat, legumes and whole grains.

·  Vitamin E

   Vitamin E  helps to maintain the integrity of cell membranes of hair follicles.

Sources of vitamin E include nuts and seeds, wheat germ oil ,sunflower, safflower, and soy bean oil, sunflower seeds, almonds ,avocado, peanuts, peanut butter, beet greens, collard greens, spinach &pumpkin.

·  Beta-carotene

Beta carotene is also important to hair growth. Include carrots, beet roots and more dark green leaves in your diet.

· B vitamins   

    Vitamins B1, B2, Niacin & Pantothenic acid are essential for hair follicular health.

Reduced levels of thiamin (vitamin B1), riboflavin (vitamin B2), niacin, and pantothenic acid can contribute to the undernourishment of hair-follicle cells. A dosage range of 25-50 mg daily is recommended.

 Vitamin B5 (pantothenic acid) gives hair flexibility, strength and shine and helps prevent hair loss and greying.

Sources of B vitamins include:

Fortified breakfast cereals, fish beans, lentils, green peas, enriched or fortified cereals, breads, brown rice, sun flower seeds ,yogurt.

 Vitamin B12 helps prevent the loss of hair and can be found in fish, eggs, chicken and milk.

  It is also important to include vitamin B6, biotin, inositol and folic acid  

     A decrease in folic acid may contribute to decreased hair-follicle cell division and growth.

Sources of folic acid include  beans ,peanuts, sunflower seeds, whole-grains, liver, seafood, eggs, fortified foods and supplements, Dungeness, crab, hard-boiled egg, beef liver

·    Biotin is important for hair growth  Biotin deficiency is rare, as intestinal bacteria are typically able to produce adequate levels of biotin. Deficiency is seen in cases of congenital or acquired biotinidase or carboxylase deficiency, antibiotic use disrupting the gastrointestinal flora, and antiepileptic use.

Deficiency can occur from excessive ingestion of raw egg whites due to binding by avidin. People who are eating adequate amount of protein should not have a problem with biotin deficiency, though vegans may be at risk.

Good food sources of biotin are eggs, liver and soy, beef liver, salmon, avocados, pork, sweet potato &nuts, seeds.

Supplements do not help most of the cases although it is routinely consumed by people.

 Proteins are also important for hair growth. include more legumes, meat, milk , egg, soy etc. in the diet.

   Homeopathic medications:

    Calcarea carbonicum, cantharis, carbonium vegetabilis,    lycopodium, natrum muriaticum,  phosphoric acid,sepia,Sulphur are commonly used by homeopaths to address triggers leading to TE hair loss. Medicines are prescribed after detailed case taking and individualized constitutional remedies are chosen analyzing the causations also.

[Disclaimer- Please take homeopathic medicines only under the guidance of a qualified homeopathic doctor in appropriate dosage. Over the counter medications may have adverse effects and we do not recommend it as homeopathy requires proper case taking, clinical examination, lab investigations , evaluation and analysis of each case in an individualized manner and selection of most appropriate remedy with proper strength &dosage for cure of any clinical condition].

 References

1.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606321/   

2.    https://pubmed.ncbi.nlm.nih.gov/12451364/   

3.    Trueb RM. Hair growth and disorders. 1st edn. Berlin: Springer; 2008. Diffuse hair loss. In: Blume-Peytavi U, Tosti A, Whiting DA, Trueb R, editors; pp. 259–272. [Google Scholar]

4.    Sinclair R. Diffuse hair loss. Int J Dermatol. 1999;38:1–18. [PubMed] [Google Scholar]

5. https://pubmed.ncbi.nlm.nih.gov/10441606/

6.SIAHMSR Medical data archives 

7. https://www.hairscientists.org/hair-and-scalp-conditions/nutrition-and-hair-health 

8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063534/

9.  Materia Medica by James Tyler Kent

10. Materia Medica by John Henry Clarke

11. Pocket Manual Of Homoeopathic Materia Medica & Repertory

12. A Concise Repertory Of Homeopathic Medicines

13. Homoeopathic Medical Repertory