The Postpartum Telogen Effluvium Fallacy

Mirallas O, Grimalt R. The Postpartum Telogen Effluvium Fallacy. Skin Appendage Disord. 2016 May;1(4):198-201.

In brief

Postpartum telogen effluvium, which is hair loss after delivery due to a sudden drop in hormone levels, is often described but does not concern all postpartum women. The review of the literature on this topic reveals that postpartum telogen effluvium might be overestimated and might even not exist.

Introduction

Telogen effluvium (TE) is a time-limited diffuse hair loss pattern that occurs usually three months after a triggering event. Such event could be febrile states, stress, major surgery, a sudden drop in hormone levels: androgens, estrogens, thyroid hormones.

Pregnancy can be considered a triggering event. Indeed, during pregnancy, there are increased levels of human chorionic gonadotropin, prolactin, progesterone, estrogens, which suddenly return to normal after delivery. These variations in hormone levels in postpartum women might play a role in TE.

Postpartum TE (PPTE), is often reported however, this observation does not concern all postpartum women.

Evidence-based understanding of Postpartum Telogen Effluvium

A review of the literature in search of PPTE evidence has spotted two studies that confront PPTE with a scientific approach. The first study, by Lynfield et al., was conducted with 26 pregnant women in total The second study, by Ekmekci et al., was conducted with 116 women, distributed into 4 different stages: at 6 and 9 months of pregnancy, and at 4 and 12 months postpartum.

The analysis of clinical data from these two published studies (total of 142 women) revealed that PPTE might be a valid clinical observation or a simple overestimation of what really occurs. This observed PPTE is enhanced by the psychological stress that translates assuming all the body changes right after delivery. PPTE seems to be overestimated by some women.

The study conducted on 26 women suffer from a lack of control parameters. The data gathered before and after pregnancy were not from the same women. Out of the 26 women, only 4 reported clinical hair loss, whereas 6 did not state any clinical hair loss. The remaining women were not assessed. There were uncontrolled factors, which vary among women and data were from different women at different stages of their pregnancy or postpartum.

The study conducted by Ekmekci et al. on 116 women reported lower anagen rate (growth phase of the hair cycle) in the 4-month postpartum group than in any of the other groups (Figure 1).

Figure 1. Anagen (growth phase of the hair cycle) versus telogen (quiescent phase of the hair cycle) rates during pregnancy and postpartum (PP) periods.

Lactation seemed to also have some influence on the anagen rate. However, the seasonal effect on hair loss was not assessed.

Conclusion

Postpartum Telogen Effluvium is not a well-defined entity. Its exact incidence is unknown or so low that Postpartum Telogen Effluvium might even not exist. Further controlled studies performed under the same biological conditions and a better follow-up would give light to this unsolved question.

Reference

Mirallas O, Grimalt R. The Postpartum Telogen Effluvium Fallacy.Skin Appendage Disord. 2016 May;1(4):198-201.