Effluvium L65.-

Non-visible, pathologically increased loss of scalp hair, which exceeds the physiological (telogenic) loss rate of 50-100 hairs/day (see hair cycle below). The visible hairlessness is called alopecia and is to be distinguished from the dynamic process of effluvium.

Depending on the findings in the trichogram, a distinction is made between:

• Anagen (-dystrophic) effluvium (anagen effluvium):
  • Anagen shutdown, immediate anagen release, during periods of physical stress, fever periods.
  • Delayed anagen release, in case of postpartum effluvium.
  • Effluvium in alopecia areata
  • Chemotherapy-induced effluvium
  • Radiation therapy-induced effluvium
  • Toxin-induced effluvium
• Telogen effluvium (telogen effluvium):
  • Telogen effluvium, immediate telogen release (shedding, e.g., with minoxidil therapy)
  • Acute telogen effluvium (febrile illnesses, injuries, severe surgical procedures, crash diets, emotional stress)
  • Chronic telogen effluvium(iron deficiency, zinc deficiency, nutritive disorders, thyroid disorders; hyperprolactinemia, etc.).

Triggers of effluvium described include:

• Seasonal change (spring and autumn)
• Infections (sudden onset of hair loss 2-4 months after infection)
• scalp diseases ( psoriasis capitis, atopic eczema, tinea amiantacea; dermatomyositis, SLE, keratosis pilaris syndrome)
• Systemic diseases (severe consumptive systemic diseases such as tumor diseases; collagenoses; chronic iron deficiency anemia).
• Hormones:
  • Telogenic (androgenetic) effluvium in males (see Alopecia androgenetica in males below).
  • Onset or discontinuation of hormonal contraception
  • (Physiological) postpartum effluvium (2-4 months after delivery)
  • Chronic telogen effluvium in women
  • Postmenopausal effluvium (see also Alopecia androgenetica in women).
• Medications (e.g., chemotherapeutic agents; see below Alopecia medicamentosa).
• Toxins (e.g., various perming procedures).
• Traction or pressure:
  • Alopecia mechanica
  • Alopecia marginalis
  • Alopecia decubitalis.
• Anagen-dystrophic effluvium: Intoxication with severe damage to anagen hair follicles leads to a transition into a dystrophic anagen phase and consecutive hair loss within a few days (early-type alopecia). In the trichogram, dystrophic anagen hairs are increased with a normal number of telogen hairs. In case of minor damage of hair follicles by subthreshold intoxications, infectious diseases or post partum, there is a premature transition of anagen phase into telogen phase. Hair loss occurs 2-4 months (late type alopecia) later. In the trichogram, increased dystrophic anagen hairs with normal number of telogen hairs.
• Telogen effluvium: Minor damage to hair follicles due to subthreshold intoxications, infectious diseases or post partum with premature transition of anagen phase to telogen phase due to minor damage to hair follicles. Hair loss after 2-4 months (late-type alopecia). Increased telogen hairs in the trichogram. See also Alopecia, see also Hair cycle.

• Anamnesis with "hair diary"
• Analysis of the hair loss rate by hair washing test (hair washing after 5 days, then estimation of the number of hairs from the sieve plate of the drain)
• Evaluation of the clinical findings with hair plucking test
• Trichoscopy
• Hair root status (trichogram)
• Laboratory analysis (routine basic laboratory, BKS, Fe, ferritin, thyroid gland values, determination of sex hormones).

Remember! A hair diary can be used to objectify the daily failure rate. It is advisable to measure the failure rate once a week (preferably under identical conditions, e.g. after a normal hair wash with shampoo; the drain must be secured with a screen plate).

1. Kantor J et al (2003) Decreased serum ferritin is associated with alopecia in women. J Invest Dermatol 121: 985-988
2. Springer K et al (2003) Common hair loss disorders. On Fam Physician 68: 93-102
3. Thiedke CC (2003) Alopecia in women. On Fam Physician 67: 1007-1014
4. Trueb RM (2010) Systematic approach for women with hair loss. JDDG 8: 284-297
5. Wolff H et al (2008) Hair loss in women - diagnosis and treatment. Close to the skin Derm 24: 10-14