Beth is a beautiful 2 1/2-year-old girl whom I have taken care of since she was born. Even as a newborn Beth had perfect facial features and a full head of strawberry blond hair. Most young infants lose a substantial amount of hair during the first few months of life, causing them to somewhat resemble a tennis ball. But this hair loss is transient and by their first birthday they are sporting a full head of hair once again.
I distinctly remember commenting to Beth’s mother during her four and six-month well checks that she still had a gorgeous head of hair. I was “jealous of her” because she had not lost any nor did it look like she would in the near future.
The schedule indicated that Beth was coming to the office for a sick-visit. I thought to myself how odd it was, given that this was the middle of summer and there had not been much illness going around. More importantly, Beth seemed to come in only for well visits...she was rarely sick.
I grabbed the chart to review before going into the room. Other than her regular well visits Beth had been in once for a suspected ear infection. This had proven to be a false alarm. She had been fussy and pulling on her ear because of teething. Regarding today’s visit the nurse had written on the chart that she had no fever and the chief complaint was hair loss.
Upon entering the room I found a pleasantly playful Beth sitting on mom’s lap reading a picture book. I instantly looked at her hair while greeting mom and making pleasantries with Beth, but nothing caught my eye. I asked mom about the hair loss. She told me that the baby started losing her hair around three-to-four weeks ago. It was nothing dramatic at first. But now, when brushing Beth’s hair, it comes out in clumps. What prompted mom to make the appointment was the fact that now it is noticeable to her and other family members.
Sitting close to Beth and studying her scalp, I could see what mom’s concerns were. The baby did not have clumps of hair missing nor did she have any bald spots. But the hair seemed to be fine and very thinned out. Mom brought in her hairbrush which was full of Beth’s hair. I studied it and found each strand to be in perfect shape with a healthy looking root. I then studied the scalp closely with a magnifying glass. There were no broken hairs. The scalp was not inflamed or irritated. There were no areas of alopecia or bald spots. Everything looked as healthy as could be.
Perplexed, I looked at Beth’s chart. Thinking out loud, I commented to mom, “Because Beth has been so healthy, it makes the diagnosis a bit more challenging...Think back. Did Beth have any significant illness in the past few months?” Mom sat there shaking her head in deep thought, and then all of a sudden her head snapped up. “Of course,” she said confidently. “Exactly two months ago we went back east to spend a week with my parents in Vermont. The day we left Beth felt a little warm to me. In fact I gave her some Motrin on the plane because I could feel that she had a fever. She was sick the first four days that we were there. She had three days of fever, up to 103 degrees. And also terrible diarrhea and vomiting. Her poor little body was like a wet noodle. We took her to my nephew’s pediatrician. He examined her and said that she had a viral infection.” Beth’s mom went on. “I have never seen a child so sick. But by the fifth day the fever broke and she turned the corner. By the time we came home, she was back to her normal bubbly self.”
“It all makes sense,” I told her. “Beth’s hair loss is a common condition called TELOGEN EFFLUVIUM.” The normal growth of hair is divided into three distinct phases: anogen, or active growth; catogen, an intermediate stage lasting only a few days; and telogen, a resting stage that lasts for around three months. A number of stimuli, or stressors, can interrupt the normal growth of hair. These can include a severe illness, serious injury, certain medications, stress, childbirth, acute blood loss, sudden weight loss, high dose steroids and oral contraceptives.
After the stressful incident, the hair enters a catogen phase, followed by a telogen or resting phase. In other words, there is a premature conversion of growing or anogen hairs, which normally constitute 80 to 90 percent of all hairs, to the resting stage. After a period of approximately three months, when the anogen phase begins, the resting hairs are forced out in large numbers. There is no treatment for telogen effluvium, nor is any really required. In almost every case normal hair growth will return in around six months. In most cases of telogen effluvium it is extremely rare for more that 50 percent of the hairs to be involved. So, it rarely causes noticeable hair loss and almost never does it cause actual bald patches.