Chronic telogen effluvium was first reported at a conference
(Alopecia, Washington DC, November 1996) and later published as
a newly identified diffuse form of hair loss in women (Whiting
1996). Very rarely has chronic telogen effluvium been reported
in men. Unlike other types of telogen effluvium, the initial onset
can be quite sudden. This form of hair loss can gradually become
quite extensive over the entire scalp. Hair thinning at the temples
can often be observed which is extremely unusual in women. The
hair thinning may fluctuate over time. It is a not a progressive
form of hair loss like androgenetic alopecia. There are no known
cases of individuals with chronic telogen effluvium developing
permanent hair loss or extensive bald regions.
Chronic telogen effluvium often occurs in women who previously
had a high hair density, very thick hair in their teens and twenties.
Sometimes this means that women who develop chronic telogen effluvium
will consult with a dermatologist and explaining extensive and
rapid hair loss yet to a casual observer the women has an apparently
normal head of hair. Whiting claims actual onset of chronic telogen
effluvium is most common in those age 40-50, although other dermatologists
have reported chronic telogen effluvium occurring in younger individuals.
This form of hair loss is not permanent although Whiting reports
it can last up to 72 months.
In chronic telogen effluvium there are a very high number of
telogen hair follicles in the resting stage during the active
stage of the disease. This means that a hair pull test is positive
with many hairs easily being pulled from the patient's scalp.
There are no miniaturized hair follicles or vellus hair fibers
unlike androgenetic alopecia. Some suggest this high number of
telogen stage follicles in chronic telogen effluvium is due to
the follicles entering a synchronized cyclic hair growth rather
than the usual mosaic pattern of growth cycles found in adult
hair follicles (Trueb 2002).
Whilst Whiting describes a fairly distinctive hair loss presentation
as chronic telogen effluvium, other dermatologists define any
diffuse hair loss in which the number of hair follicles in telogen
is increased as a "chronic" telogen effluvium. This
has created some confusion in professional circles and in patients.
Any form of telogen effluvium can become "chronic" (defined
as telogen effluvium persisting for more than 6 months) if the
activation event persists. For example, telogen effluvium may
become chronic if the hair loss was initiated by a deficiency
of iron, vitamin B12, folate, or protein and the deficiency is
not corrected. Persistent hypothyroidism can also induce a chronic
form of telogen effluvium as might a chronic infection. However,
this telogen effluvium presentation is distinct from the description
of chronic telogen effluvium given by Whiting, Sinclair and others.
In these cases other contributing factors have been ruled out
with tests and the cause of chronic telogen effluvium is unknown.
Whiting suggests there is probably a genetic contribution to chronic
telogen effluvium although no research has been conducted to demonstrate
this.
