05/05/2020
Preventative Strategies using Nutritional supplements and Botanical Medicine to Support Wellness, Stress & Hair Loss.
An important note
With the 2019 coronavirus COVID-19 pandemic, it is important to understand that no supplement, diet, or other lifestyle modification other than social distancing and proper hygiene practices can protect you from COVID-19.
Implementing preventive strategies can help to place you among the 80% with mild to minimal illness before you are exposed.
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Febril Telogen Effluvium
Febril Telogen effluvium is a form of non-scarring alopecia characterized by diffuse, often acute hair shedding. Febril Telogen Effluvium is a reactive process, triggered by metabolic stress, hormonal changes, or medications. Common triggering events are acute febrile illness; severe infection; major surgery; severe trauma; postpartum hormonal changes, particularly a decrease in estrogen; hypothyroidism; discontinuing estrogen-containing medication; crash dieting; low protein intake; heavy metal ingestion; and iron deficiency. Many medications have been linked to telogen effluvium, but the most common are beta-blockers, retinoids (including excess vitamin A), anticoagulants, propylthiouracil, carbamazepine, and immunizations.
Febril Telogen effluvium can occur in people of any age, any gender, and any racial background. Telogen effluvium can occur in either s*x, though women have a greater tendency to experience this condition because of postpartum hormonal changes.
Febril Telogen effluvium is triggered when a physiologic stress causes a large number of hairs in the growing phase of the hair cycle (anagen) to abruptly enter the resting phase (telogen). The growth of the telogen hairs ceases for 1 to 6 months (on average 3 months), though this cessation of growth is not noticed by the patient. When the hairs reenter the growth phase (anagen), the hairs which had been suspended in the resting phase (telogen) are extruded from the follicle, and hair shedding is observed.
Patients will report hair shedding, usually without other symptoms, with a relatively abrupt onset. By definition, in acute telogen effluvium, shedding lasts less than six months; often the period of shedding is much shorter. A careful history will identify a causative event occurring approximately 3 months before the onset of the shedding (range from 1 to 6 months). Quite often the patient has fully recovered from the acute illness and fails to see the connection between the illness and their hair loss.
Scalp biopsy is the most useful test to confirm the diagnosis, but it is seldom necessary if gentle hair pull produces numerous telogen hairs. Telogen hairs can be identified by a white bulb and no gelatinous hair sheath.
If a patient is unwilling to allow a scalp biopsy, serial hair collections can be obtained.
The patient should be instructed to collect all shedding hair in a 24-hour period. The patient should avoid washing the hair during the collection. This process should be repeated every week for a total of 3 or 4 collections.
Collecting 100 hairs or more hairs in a 24-hour period suggests telogen effluvium. If the collections are performed over several weeks while the telogen effluvium is improving, the number of hairs collected may decrease.
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Treatment / Management
Acute telogen effluvium is a self-limited condition. If the causative event is identified by history and has been adequately treated, there is no further treatment required. If a hormonal or dietary imbalance or metabolic illness is present, hair growth will return after these factors are corrected. If a medication is the cause of the shedding, hair growth will restart after the medication is withdrawn.
While topical minoxidil has not been proven to promote recovery of hair in telogen effluvium, it has theoretical benefit. Patients who wish to take an active role in their treatment may choose to use minoxidil.
It may take up to 6 months for hair growth to restart, and even longer for the growth to be appreciable by the patient. Patients often require reassurance of the normal recovery of their hair while the hair reenters anagen and grows normally. Patients may also worry that normal grooming of their hair worsens the hair shedding. Patients should be reassured that their hair is normal and that they can wash and style their hair as usual.
