REACTIVE HAIR LOSS: THE PROTOCOL 

Designed by Dr. Julie Pernet, Doctor of Pharmacy and certified Trichologist

"I'm losing handfuls of hair. Every time I shampoo, every time I run my hands over it, it falls out. My hair has lost so much volume, I'm afraid I'm going bald."

If you recognize yourself in these statements, know one essential thing: you are not alone. Telogen effluvium is one of the most common causes of diffuse hair loss, in both women and men. And most importantly: in the vast majority of cases, it is reversible.

I am Dr. Julie Pernet, a Doctor of Pharmacy and certified trichologist. I have helped hundreds of people who, like you, dreamed of stopping their hair loss. I have designed a specific protocol with a clear objective:
➔ Stop your hair loss and restore your hair density

What is telogen effluvium?

Telogen effluvium is a diffuse, non-scarring alopecia, meaning hair loss distributed across the entire scalp without permanent destruction of the follicles. It is the second most common cause of non-scarring alopecia, after androgenetic alopecia. It corresponds to a premature and massive transition of hair follicles from the growth phase (anagen) to the resting phase (telogen).

The result: a few weeks to a few months later, these hairs all enter the shedding phase… at the same time.

The normal hair cycle

Hair growth follows a hair cycle made up of 3 main phases:
■  Anagen (growth) phase Hair grows actively for 2 to 6 years. This is the longest phase.
■  Catagen phase (transition) : the hair stops growing, the follicle shrinks. This phase lasts about 2 to 3 weeks.
■  Telogen phase (shedding) : the hair dies and falls out, making way for new hair. This phase lasts 2 to 3 months.

In telogen effluvium, this ratio is completely unbalanced: up to 30–40% of the hairs can abruptly switch to the telogen phase.

Understanding hair loss:

Why does the fall occur with a delay?

The triggering event usually occurs 2 to 3 months BEFORE the onset of visible hair loss. This is why many people say, "I'm losing my hair for no reason."

The reason exists, but you have to go back 2 to 3 months to understand it.

Diagnosing telogen effluvium

This is a crucial question, as not all hair loss is telogen effluvium. In my practice, I very often see confusion, particularly with early-stage androgenetic alopecia or certain types of hair loss related to scalp inflammation.

Telogen effluvium is primarily a diagnosis of context and dynamics.

Signs that strongly point towards telogen effluvium

■ Sudden and massive drop, appearing in a few weeks
■ Diffuse hair loss across the entire scalp (forehead, temples, crown, back)
■ Hair found in large quantities on the pillow, in the shower or on the brush
■ Rapid reduction in overall volume, without completely bald patches
■ Hair that has fallen out with a white, dry bulb, typical of the telogen phase
■ Presence of an identifiable triggering factor 2 to 3 months prior: significant stress, pregnancy or postpartum, illness, fever, surgery, deficiency, intense fatigue

Signs that should raise doubt about isolated telogen effluvium

Certain elements should raise concern and prompt further diagnosis:
■ Hair loss that persists beyond 9 to 12 months without significant improvement
■ Gradual thinning of the hair, especially at the temples or the crown of the head
■ Differences in diameter between hairs (miniaturization)
■ Significant family history of androgenetic alopecia

In these situations, telogen effluvium often reveals or accelerates underlying androgenetic alopecia.

The trichoscope remains the reference tool to confirm the diagnosis: it allows analysis of hair density, diameter and the anagen/telogen ratio.

Free diagnostic sessions Did you know that the DermoPilaire MakeMyMask Laboratory regularly organizes free hair diagnostic sessions using a trichoscope? These sessions allow for a precise analysis of the scalp and identify the cause of hair loss or imbalance. Register now! here to be informed of upcoming sessions organized near you.

The pull test to diagnose telogen effluvium?

The pull test is a very simple clinical test, used in dermatology and trichology to assess the intensity of active hair loss.

How to perform the pull test correctly?

1) Do not wash your hair for 24 to 48 hours
2) Select a strand of approximately 50 to 60 hairs
3) Pull gently but firmly, close to the scalp
4) Count the number of hairs extracted

The test should ideally be performed on 3 different areas:
■ Frontal
■ Temporal
■ Occipital

How to interpret the results?

■ 0 to 2 hairs: physiological shedding
■ ≥ 4 to 6 hairs: positive pull test → active hair loss

In telogen effluvium, the pull test is often clearly positive in all areas, indicating diffuse and non-localized hair loss.
The recovered hairs almost always have a white bulb, characteristic of the telogen phase.

Please note : the pull test is not sufficient to make a diagnosis on its own, but it is an excellent indicator to point towards telogen effluvium when associated with the clinical context.

The causes of telogen effluvium

Telogen effluvium is an adaptive response of the body to physiological or psychological stress.

Most frequent causes (non-exhaustive)

■  Acute or chronic stress
Intense emotional stress, burnout, anxiety, psychological shock, depressive states

■  Pregnancy and postpartum
A sudden hormonal drop after childbirth, postpartum telogen effluvium, is very common and physiological.

■  Prolonged febrile episodes or severe infections
Flu, COVID, major infections

■  Endocrine disorders
Thyroid dysfunction (hypothyroidism or hyperthyroidism)

■  Nutritional deficiencies
Iron deficiency (with or without anemia), zinc deficiency, B vitamin deficiency, protein deficiency, low-calorie diets or rapid weight loss

■  Surgeries
Surgery with prolonged anesthesia, significant bleeding

■  Inflammatory scalp dermatoses
Psoriasis, seborrheic dermatitis

■  pharmaceuticals
Retinoids, antiepileptics, beta-blockers, lithium salts, antidepressants, NSAIDs (indomethacin), anticoagulants, lipid-lowering drugs

These causes are widely described in the dermatological and trichological literature (Harrison & Sinclair, Clin Dermatol, 2002; Malkud, J Clin Diagn Res, 2015).

Evolution & prognosis

Good news: in most cases, telogen effluvium is reversible!

The fall usually lasts 3 to 6 months
■ Regrowth then begins spontaneously
■ Full recovery can take 5 to 8 months, sometimes longer depending on the individual.
■ The follicles are not destroyed: they are simply "put to rest".

My recommendations for treating telogen effluvium

To hope for lasting effectiveness, it is essential to adopt a comprehensive approach, which is not limited to masking the external signs, but which also acts on the reasons which prevent hair from growing.

That's why I created a Anti-Reactive Hair Loss Protocol which contains 4 complementary products to stop reactive hair loss and thicken hair.

Proven effectiveness against telogen effluvium

Healthy lifestyle & stress management

A healthy lifestyle is essential because oxidative stress weakens hair follicles and lack of physical activity slows down microcirculation in the scalp.
■ Regular gentle physical activity: 30 min of walking, yoga or swimming 3x/week
■ Restorative sleep: 7 to 8 hours per night, avoid screens in the evening
■ Stress management techniques: cardiac coherence, meditation, breathing
■ Psychological support (if chronic stress or strong emotional impact)

In conclusion

■ Telogen effluvium is common, dramatic, but most often reversible
■ The fall is delayed in time relative to the cause
■ A comprehensive approach is essential
■ The scalp and the body must be treated together

If you have any doubt about the type of fall you experienced, a precise diagnosis is essential to avoid errors in care.

You haven't lost your hair permanently. You're going through a temporary imbalance. And it's possible to get through it.