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.

A distinction is made depending on the findings in the trichogram:

• Anagenes (-dystrophic) effluvium (anagen effluvium):
  • anagen release, immediate anagen release, during periods of physical stress, fever periods.
  • delayed anagen release, for postpartum effluvium.
  • Effluvium in alopecia areata
  • chemotherapy-induced effluvium
  • radiation therapy induced effluvium
  • toxin-induced effluvium
• Telogenic effluvium:
  • Telogen switch-off, premature (immediate telogen release, so-called "shedding" e.g. with minoxidil therapy)
  • Acute telogen effluvium (febrile diseases, injuries, serious surgery, crash diets, emotional stress)
  • Chronic telogen effluvium (iron deficiency, zinc deficiency, nutritive disorders, thyroid diseases; hyperprolactinemia, etc.).

The following are described as triggers for effluvium:

• Seasonal change (spring and autumn)
• Infections (sudden hair loss 2-4 months after infection)
• Scalp diseases ( psoriasis capitis, atopic eczema, tinea amiantacea; dermatomyositis, SLE, keratosis pilaris syndrome)
• Systemic diseases (severe consuming systemic diseases such as tumour diseases; collagenoses; chronic iron deficiency anaemia).
• Hormones:
  • Telogenic (androgenetic) effluvium in men (see below Alopecia androgenetica in men)
  • hormonal contraception on or off
  • (Physiological) postpartum effluvium (2-4 months after delivery)
  • Chronic telogenous effluvium of women
  • Postmenopausal effluvium (see also Alopecia androgenetica in women).
• Drugs (e.g. chemotherapeutic agents; see below Alopecia medicamentosa).
• Toxins (e.g. various permanent wave procedures)
• tension or pressure:
  • alopecia mechanica
  • alopecia marginalis
  • Alopecia decubitalis.
• Anagen-dystrophic effluvium: In intoxication with severe damage to anagen hair follicles, a transition to a dystrophic anagen phase occurs 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. If the hair follicles are slightly damaged by subliminal intoxication, infectious diseases or post partum, there is a premature transition from the anagen phase to the telogen phase. Hair loss occurs 2-4 months later (late type alopecia). In the trichogram, dystrophic anagen hair increases with a normal number of telogen hairs.
• Telogenic Effluvium: Minor damage to the hair follicles due to subliminal intoxications, infectious diseases or post partum with premature transition of the anagen phase to the telogen phase due to minor damage to the hair follicles. Hair loss after 2-4 months (late type alopecia). In the trichogram increased telogen hairs. See alopecia below, see hair cycle below.

• 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