A Case of “Telogen Effluvium” Cured by Individualized Medicine

Acute telogen effluvium refers to sudden onset of scalp hair loss occurring 2 to 3 months after a triggering event such as a high fever, surgical trauma, sudden starvation, or hemorrhage. While emotional stress is often linked to this condition, evidence supporting this connection is weak, and there is no indication that the stress of daily life alone can cause widespread hair loss. The primary mechanism behind hair loss is the immediate release of anagen hairs. Patients may notice increased hair loss during brushing, combing, or shampooing, with daily losses ranging from under 100 to over 1,000 strands. If shedding occurs at lower rates and for a short duration, baldness may not be apparent, but higher rates can lead to a diffuse reduction in hair density. Spontaneous and complete regrowth typically occurs within 3 to 6 months unless the triggering event is repeated. Abrupt-onset telogen effluvium is often linked to a specific event or trigger 6 to 16 weeks earlier. In acute telogen effluvium, the hair pull test is positive, with normal club hairs, and there is usually a strong positive presence of telogen hairs at the vertex and the scalp margins.[1]

A 42-year-old male patient presented with a 1-year history of diffuse hair fall that aggravated while washing and oiling the hair and massaging the scalp. Severe itching in the scalp region was also present ([Fig. 1]). Careful history-taking revealed that the patient was under severe stress due to business issues on and off for the last 1.5 years before the problem began. The patient was loquacious and had fear of high and dark places. He preferred warm food and had great thirst with an addiction to tea (12–16 cups/d). He was a thermally hot patient. At the hair pull test, there were 8 to 9 hair strands/pull.

Fig. 1 Before treatment.

Typically, dandruff is the earliest sign of seborrheic dermatitis and it is characterized by redness, irritation, and increased scalp scaling. The presence of elevated levels of Malassezia yeast in the scaly epidermis is a characteristic of seborrheic dermatitis. The absence of dandruff, redness, and scaling serves as a distinguishing factor between Malassezia-related manifestations and telogen.[1] A diagnosis was made through clinical presentation and history. In our patient, the triggering event, that is, business issue, persisted for a longer duration on and off for 1.5 years, which led to abrupt onset of telogen. Regrowth was also prevented due to repetition of this triggering event.[1] [2] [3]

Following a thorough case history recording on a structured proforma, analysis and evaluation of the symptoms was done, the totality of the symptoms was constructed, and after repertorization, the appropriate homoeopathic medicine was chosen. Synthesis repertory [4] was used for repertorization. The top two medicines that covered the totality were Calcarea carbonicum and Natrum muriaticum. Since the patient was thermally hot, Calcarea was excluded after further verification from Boericke's Materia Medica.[5]

• First prescription: Natrum muriaticum 200/1 dose/stat followed by placebo for 14 days.

• After 14 days: Natrum Muriaticum 200/1 dose/stat was given followed by placebo for another 14 days.

• Further, placebo was continued for 3 months. Hair growth started in the previously visible scalp area.

• After 3 months, there was complete hair growth in the previously visible scalp area ([Fig. 2]).

Fig. 2 After 3 months complete hair growth was visible in the previously bald scalp area.

Patients' Consent

The authors certify that they have obtained all appropriate patient consent for use of the images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Publication History

Article published online:
26 March 2024

• References

• 1 Burns T, Breathnach SM, Cox NH, Griffiths C. Rook's Textbook of Dermatology. 7th ed., Vol. 4.. Philadelphia, PA: Blackwell Science; 2004: 17.10-17.12 , 63.32
• 2 Harrison S, Bergfeld W. Diffuse hair loss: its triggers and management. Cleve Clin J Med 2009; 76 (06) 361-367
• 3 Asghar F, Shamim N, Farooque U, Sheikh H, Aqeel R. Telogen effluvium: a review of the literature. Cureus 2020; 12 (05) e8320
• 4 Schroyens F. Synthesis 9.1: English. 1st ed.. Cambridge, UK: RSC Publishing; 2023
• 5 Boericke W. Pocket Manual of Homoeopathic Materia Medica. 9th ed.. New Delhi: IBPP; 2015: 129 , 408