By Gary M. White, MD

Telogen effluvium

Telogen effluvium is the loss of hair on the scalp starting about 2-3 months after a stressful event--either emotionally or physically. Common triggers include significant weight loss, labor and delivery, surgery, or severe psychological stress.


The patient, usually a woman, complains of loss of hair diffusely, but mainly across the top and along the frontal hair line. She may bring in a bag of hair to show you (see below, "bag of hair sign"). The hair pull test is positive in the acute phase. Microscopic examination of the hair shows an excess of club hairs. One proposed variant is chronic telogen effluvium which is defined as chronic diffuse scalp hair shedding for more than 6 months. In this case, the severity may wax and wane. Some have defined chronic telogen effluvium as diffuse hair loss that includes the occipital area (to exclude androgenetic alopecia).


Workup should include thyroid function, ferritin, vitamin D and zinc levels. Ferritin should be above 40 ng/ml. If the ferritin is below 40, see iron deficiency alopecia.

Differential Diagnosis

See hair loss in a woman.


As long as the stress is removed, hair regrowth may be expected. Any deficiencies in iron, vitamin D, zinc or thyroid should be corrected.

Additional Pictures

The "bag of hair" sign.
telogen effluvium, the bag of hair sign


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