Workup for telogen effluvium

Despite what sophisticated publications would suggest, effective trichological practice is not a closed art, to be mastered only after years of perfecting and struggling with the mysteries of hair growth and shedding. This particularly holds true for telogen effluvium (TE), a common condition, that is neither poorly understood, nor limited in its treatment options, as opposed to the other common hair loss disorders, particularly patterned hair loss, alopecia areata, and the scarring alopecias. Cyclic hair growth activity occurs in a random mosaic pattern with each follicle possessing its own individual control mechanism over the evolution and triggering of the successive phases, though systemic and external factors linked to the environment, have influence, such as: hormones. cytokines and growth factors, toxins, and deficiencies of nutrients, vitamins, and energy (calories). In fact, whatever the cause, the hair follicle tends to behave in a similar way. By definition, TE results from increased shedding of hairs from the telogen phase of the hair cycle. While several attempts have been made with respect to the underlying pathologic dynamics of TE and its classification, Headington’s original classification remains unabated the most rational of all proposals so far, and the most comprehensive. As with any medical problem, TE requires a comprehensive medical and drug history, physical examination of the hair and scalp, and appropriate laboratory evaluation to identify the cause. Once the diagnosis is certain, therapy appropriate for that diagnosis is likely to control the problem. Identifying and effectively treating the culprit will usually be successful, as protocolled by daily hair counts, and standardized global photography in tandem with epiluminiscence microscopy with or without digital image analysis on follow-up visits.