Recovery from Post Surgical Telogen Effluvium

Telogen Effluvium After Surgery

Telogen effluvium (TE) is a form of hair loss that is associated with an increased amount of daily hair shedding. Instead of losing 50-100 hairs daily, patients with TE lose a far greater amount.  There are many so called 'triggers' of TE including stress, low iron, thyroid problems, medications, diets. Many patients experience TE after hospitalizations - especially if surgery was the reason for the hospitalization.

Post Surgical Telogen Effluvium

Not everyone experiences hair loss after surgery. But if it does occur, it often occur 2-3 months after surgery. A variety of factors influence whether hair loss will or will not occur. Some are similar patient intrinsic factors that are poorly understood. These influence one's risk of developing a TE in the first place. But factors like type of surgery, length of surgery, medications and anesthetics used, blood loss, weight loss, nutrition all influence the likelihood of shedding.

Sequelae of TE: Will hair shedding stop? Will hair grow back?

There are three things that can happen to an individual who develops hair shedding after surgery:

1) The hair sheds and then grows back to the same density in 6-9 months. This would be the 'classic recovery' in TE.

2) The hair sheds and then the shedding rate slows down but shedding rate is still higher than normal and the hair density does not seem to return quite back to normal. In such a case, the patient may be developing persistent TE or chronic TE.

3) The shedding rate eventually goes back to normal but the hair density remains thinner and never quite comes back the same. In such a case, the patient may have developed worsening of another type of hair loss, such as androgenetic alopecia. The TE may have resolved but another hair loss condition has taken over as more pressing. 

Evaluation of Post Surgical TE

The key to addressing telogen effluvium from surgery is trying to determine the exact cause. If it was factors such as stress, weight loss, medications or anesthetics in hospital, those triggers are presumably gone by the time the patient develops or notices shedding. Waiting (rather than active treatment) is one very good option in this situation as hopefully the hair will grow back in 6-9 months.

If the 'trigger' was actually due to a deficiency in some mineral or metal (iron and zinc deficiency are common after bowel surgery) or some hormonal issue (thyroid issues are common in hospitalized patients)... then the hair will only properly grow back when these specific issues are addressed. The key to treating a telogen effluvium is addressing the trigger.

 A few in depth blood tests would be appropriate before deciding to treat or wait. The specific tests to order in any given patient will differ depending on their story, but tests for CBC, TSH, ferritin, zinc, 25 hydroxy-vitamin D, calcium, ESR, ANA can be considered. Other tests may be appropriate as well including imaging tests (Chest X-ray, etc).

Treatment of TE

Sometimes the exact trigger can’t be confidently agreed upon in a post surgical patient and one needs to make a decision as to whether they want to wait and see what happens or treat with non-specific hair growth stimulators like minoxidil (Rogaine) or low level laser or vitamins. These all encourage hair growth. One must keep in mind that if the trigger has not adequately been addressed (i.e. the patient actually has an undiagnosed thyroid disorder), these growth stimulators will be less effective.