hair

Effluvio and Defluvio - Causes of Hair Fall

What is the Effluvio?

Effluvio and defluvio are terms widely used in dermatology, particularly in the trichological field. Evaluating whether the loss of hair has the character of an effluvium or an effluvium, acute or chronic, is in fact fundamental to frame the problems of thinning and to remedy them.

Not surprisingly, the clinical classification of alopecia is often placed on the basis of the amount of hair lost. In this sense, the effluvia are distinguished by quantitatively significant losses of hair in the unit of time, from the floods, in which the hair loss is slower and more contained.

A sub-classification also examines the growth phase in which fallen hair is found.

Capello's Life Cycle

In order to better understand the following classification of effluvia and effluvia, it may be useful to open a small parenthesis on the different vital phases of the hair.

In this regard, we briefly recall that the life cycle of a hair consists of three contiguous phases:

  • Phase Anagen : is the growth phase, which affects at the same time percentages varying between 80% and 90% of the hair; its duration, of several months or even years, tends to decrease in the presence of androgenetic alopecia.
  • Catagen phase : is the phase of hair loss and lasts about two weeks.
  • Telogen phase : it is the resting phase of the hair that precedes the fall (catagen), and lasts about 100 days. The length of this period tends to increase in the presence of androgenetic alopecia, up to the inversion of the temporal relationship between anagen and catagen.

We can therefore talk about effluvia in anagen, effluvia in telogen, floods in anagen and flow in telogen.

The vital phases of the hair can be assessed by an examination called a trichogram .

Effluvius in Anagen

The effluvium in anagen is characterized by the loss of hair in the amount of several hundred, or even thousands of units, in the anagen phase, in fact (ie, in the growth phase). This condition occurs classically a few days after a particularly stressful event that can be physical or psychic and among which we find:

  • Poisonings;
  • Aproteic diet;
  • Anti-cancer chemotherapy;
  • Exposure to ionizing radiation, as happens, for example, in the case of anticancer radiotherapy;
  • Taking some types of drugs or substances (such as, for example, cytostatic drugs, arsenic, thallium, bismuth, etc.).

Furthermore, the anagen effluvium is typical of alopecia areata, which is characterized precisely by a heavy effluvium during the phase of hair growth, but only in circumscribed areas of rounded shape.

Generally, anagen effluvium is self-limiting and lost hair grows back spontaneously if the stressful event does not recur.

For this reason, the main treatment of anagen effluvium consists precisely in the removal of the triggering factors.

As regards the treatment of alopecia areata, instead, we refer you to the reading of the dedicated articles already present on this site.

Effluvium in Telogen

The effluvium in telogen can, in turn, be classified in effluvium in acute telogen and in effluvium in chronic telogen.

Effluve in telogen Acuto

The effluvium in acute telogen is characterized by an intense and conspicuous loss of hair (hundreds and sometimes even thousands) whose main cause is to be found in particularly stressful and short-lived events and situations, such as:

  • Accidents;
  • Lutti;
  • Parto;
  • Surgical interventions;
  • Bleeding;
  • Febrile diseases;
  • Poisonings;
  • Other acute physical or psychological stresses of various kinds.

However, the effluvium in telogen of acute type does not manifest itself as a direct consequence of the aforementioned events, but rather about three months after these events.

Fortunately, the phenomenon is self-limiting and tends to resolve spontaneously over a few months. The ideal treatment of this form of effluvium, therefore, should consist only in the removal of the factor that caused the stress. However, in many cases, doctors still prescribe therapy to the patient, so as to reassure him.

Regardless, the use of corticosteroids (normally used in the chronic form) can be very useful also in the acute form. Generally, these drugs are administered topically.

Effluvium in telogen Chronic

The chronic form of the effluvium in telogen seems to involve women more than men and is characterized by a significant loss of hair without seasonal variations (as, instead, should occur under normal conditions), therefore relatively constant over time. The effluvium in telogen of this type is generally linked to a chronic hair growth disorder, often without tendency to spontaneous resolution.

Among the main causes of chronic telogen we recall:

  • Frequent blood donations;
  • Serious mental illnesses;
  • thyroid disorders;
  • Chronic systemic diseases;
  • Prolonged use of certain types of drugs (such as retinoids, interferon, heparin, some oral contraceptives, allopurinol, etc.);
  • Nutritional deficiencies;
  • Etc.

Unlike the acute form, the chronic telogen effluvium does not tend to spontaneously resolve itself and the patient will face a gradual and inexorable thinning.

The treatment of the effluvium in chronic telogen foresees to intervene on the triggering cause, which can be associated with the administration of corticosteroids topically, or, in the most serious cases, systemically.

Defluvium in Anagen

It is characterized by a hair loss above the norm, but without the dramatic characteristics of the effluvium. The thinning is due to the progressive loss of the follicles, secondary to their destruction. This destruction is the consequence of pathological situations that lead to the total destruction of hair follicles.

The flood in anagen is typical of cicatricial alopecias and can occur as a result of diseases such as:

  • Lichen planus;
  • Discoid lupus erythematosus;
  • The alopecitating folliculitis;
  • Linear scleroderma (morphea);
  • The pseudoarea of ​​Broq (a particular form of cicatricial alopecia);
  • Trichomalacia;
  • Radiation alopecia.

Flood in Telogen

In most cases, hair loss is characterized by a flood of telogen. This is in fact the characteristic manifestation of androgenetic alopecia, a condition linked to the activity of androgenic hormones in a genetically predisposed medium; as anticipated, this disease is characterized by a moderate fall of the hair, accompanied by their gradual involution (they become increasingly thin, short and depigmented). Unlike the flood in anagen, in the androgenetic alopecia the follicle is preserved, but it becomes more and more superficial.

In addition to androgenetic alopecia, both male and female, in women the defluvium in telogen is also accompanied by states of:

  • hyperprolactinemia;
  • Nervous anorexia;
  • Polycystic ovary syndrome;
  • Androgen-secreting neoplasms;
  • Hypoestrogenism (menopause, post-partum, suspension of the contraceptive pill, etc.);
  • Adrenal enzyme deficiency.

The treatment of male androgenetic alopecia normally involves the administration of drugs such as finasteride and minoxidil. The latter active ingredient can also be used for the treatment of female androgenetic alopecia, which can be associated with an estrogen-based therapy. However, for more detailed information on this, we recommend reading the dedicated articles on this site.