by Dr Deborah Lee, Dr Fox Online Pharmacy
by Dr Deborah Lee, Dr Fox Online Pharmacy
Hair loss is incredibly common and very distressing. Google searches for hair loss are at an all-time high. An incredible 8 million UK women experience hair loss. 50% of men over 50 have hair loss. But did you know that stress is very often an underlying cause? In fact, Women with stressful jobs are thought to have an eleven times increased risk of hair loss.
Reasons for stress and hair loss
When you’re told the reason for losing your precious locks is down to stress, thiis can be hard to believe. We all have stress. Why should this stress cause hair loss? Let me try and explain.
Many proteins and hormones are released in the body as a result of stress, many of which have a detrimental effect on hair growth. The hair follicles themselves produce stress mediators themselves as part of a ‘skin-stress response’.
- Substance P (SP) – This small molecule is released at nerve endings in response to stress. It is known to set off the cascade of inflammation, and hence this may be one reason why stress can exacerbate eczema and psoriasis. It also causes mast cells to release tumour necrosis factor alpha, interleukin 1 and proteases all of which disrupt the hair growth cycle. Oxidative stress – which occurs every day in the human body – stimulates the production of SP.
- Nerve growth factor (NGF) – A small molecule which acts as a chemical messenger within the hair follicle. In mice, NGF has been found to cause regression of hair follicles.
- Catecholamines – Adrenaline, noradrenaline, and dopamine are all increased by stress. Adrenaline slows the production of keratinocytes, which play an important role in the growth and development of the hair follicle. Keratinocytes simulate melanocytes – cells which are responsible for the pigmentation of hair and skin. This may be why severe acute stress can turn someone prematurely grey.
- ACTH – Stress leads to an increase in adrenocorticotrophic hormone (ACTH) which in turn leads to excess production of cortisol. ACTH itself plays a role in steroid metabolism within the hair follicle.
- Cortisol – High levels of cortisol have been shown to reduce the production of proteoglycans – these are the connective tissue ‘scaffolding’ that holds cells together, vital for the growth and production of hair.
- Endorphins – These are raised as a result of stress and this is known to damage hair growth.
- Prolactin – Chronic stress leads to raised prolactin levels. Prolactin is known to prevent elongation of the hair shaft and prolong the catagen phase – this is the time in the hair growth cycle when hair growth naturally stops and usually lasts only about ten days.
Telogen effluvium
In normal hair growth, 85% of the hair is actively growing – the anagen phase – and the remaining 15% are in a resting phase – the telogen phase. A healthy hair will be in the anagen phase for around 4 years and the telogen phase for around 4 months. Hair is shed when the new anagen phase hair grows underneath a telogen hair and pushes it out of the scalp.
Acute stress can suddenly cause up to 70% of the anagen hairs to be shunted into the telogen phase. As a result, 2-4 months after the onset of the particular shock or stress, a lot of hair falls out all at once. This is commonly seen after pregnancy, for example.
If stress is chronic, these changes can be persistent, and women may continue to lose hair for many years. Stress appears to cause the anagen period seems to readjust to a shorter time span, and this may never recover.
The diagnosis of stress-induced hair loss can be confirmed by a trichologist. The differential diagnosis includes female pattern hair loss, male pattern hair loss, diffuse alopecia areata, anagen effluvium and hair shaft defects.
How to manage stress-related hair loss
It’s very distressing when you feel you are losing your hair. It causes intense suffering and can affect your ability to function socially and your work. Hair loss has severe psychological effects including loss of self-esteem, poor body image, loss of confidence, depression, and anxiety.
See your doctor if you are concerned about hair loss sooner rather than later. The doctor will ask questions and is likely to arrange blood tests to rule out common causes such as iron deficiency, or a low thyroid hormone level.
There are a range of different types and causes of hair loss, and once a diagnosis is made, the best treatment can be offered. You may need to see a consultant dermatologist.
You may prefer to arrange to see a hair specialist – a trichologist. This is not available on the NHS. You can find a qualified trichologist here.
Here are some tips on how to deal with stress-related hair loss.
- Be gentle with your hair and handle it as little as possible. Don’t use abrasive hair ties or pull your hair into firm styles like tight braids.
- Hair washing – Trichologists advise that it makes no difference how often you wash your hair. If you wash it every 2 or 3 days, instead of every day, you will just lose additional hair each time you wash it. It is important to use the correct shampoo and conditioner to nourish the hair and the hair follicles.
- Treat any underlying medical conditions – Your GP will advise you to make sure any underlying scalp conditions are properly treated
- Rule out any hormonal deficiencies such as hypothyroidism, and make sure these are properly treated. If you are menopausal, you may want to consider HRT.
- Follow a varied, balanced, nutritionally complete diet. This means plenty of protein, along with fruit and vegetables as these contain high levels of antioxidants. This is vital to help combat oxidative stress that affects hair growth.
- Ensure levels of iron, folate and B12 are adequate. If you need to follow any kind of restrictive diet, consider taking vitamin and mineral supplements.
- Destress – Make time in your life to destress and make this part of your daily routine. Find a way to enjoy relaxation – this might be yoga, meditation, use of a hot tub or sauna. Take regular exercise which is good for stress and improves your blood circulation for your hair follicles. You might find keeping a daily journal helps relieve stress. Some people will benefit from joining a support group. If you can identify a major stress in your life that could be underlying your hair loss, it’s a good time to consider counselling. What can you do to remove this stress from your life for good?
- Stop smoking – smoking accelerates hair loss. There are over 7000 chemicals in cigarette smoke, many of which have negative effects on your hair follicles, reducing blood flow and increasing oxidative stress. Smoking makes your hair drier and more brittle.
For more information
American Family Physician – Hair loss, common causes and treatment