Chronic, short-term, and emotional stress can significantly impact our overall well-being, both physically and mentally. While hair loss isn't always a direct consequence of stress, it's a common occurrence that can lead to feelings of frustration and self-consciousness. Fortunately, stress-induced hair loss is often temporary and can improve once the underlying stressor is addressed. Seeking prompt treatment is vital as addressing the cause of hair loss early can lead to better treatment outcomes.
Yes, chronic or emotional stress can cause hair loss or hair thinning. However, it's important to note that not everyone experiencing stress will develop hair loss. Stress-induced hair loss commonly occurs in individuals who have undergone a stressful event, such as an injury, a difficult recovery from illness, the loss of a loved one, divorce, or another form of chronic stress that affects their overall well-being.
These significant stressors or stressful events can lead to increased systemic levels of stress hormones, which prematurely force hairs out of the anagen (growth) phase and into the telogen (resting) phase of hair growth. Stress-related hair loss typically begins two to three months after a significant stressor or stressful event. Luckily, many patients who experience stress-related hair loss find it temporary, and hair will often grow back after the stress has been managed. As it can take a while for hair to grow back, hair restoration treatments such as platelet-rich plasma (PRP) injections, oral medications, and topical therapies can be used to help thicken and regrow hair.
There are four distinct phases in the natural hair growth cycle:
Disruption in the natural hair growth cycle can cause devastating effects, including significant hair shedding or patchy hair loss. Typically, when stress leads to thinning hair, this indicates that the hair growth cycle has been disrupted. Chronic stress can increase the body’s cortisol levels, affecting various aspects of regular activity in the hair follicles and resulting in hair loss. One of the effects is an increase in the number of hair follicle stem cells entering a dormant stage, which can lead to a large amount of hair shedding all at once. Many different stressors can cause this shift in the body, including hormonal changes such as postpartum shifts or menopause, as well as emotional stress.
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Stress-related hair loss can manifest in several ways:
Telogen effluvium is one of the most common types of hair loss and is caused by hair follicles undergoing an extended resting phase, resulting in diffuse hair shedding. Telogen effluvium is a shift of many hairs into the telogen phase, resulting in abrupt, diffuse shedding of scalp hair. Symptoms of telogen effluvium typically won’t present until two or three months after a stressful event or chronic stress, after which hairs in the telogen phase will be released from the hair follicle and induce shedding.
Patients often observe diffuse hair loss caused by telogen effluvium as “en-mass” hair shedding, appearing as overall hair thinning or hair loss rather than a widening part or gradual thinning in specific areas. Oftentimes, patients will notice a substantially thinner ponytail or an increase in the amount of hair shed while combing or shampooing as an indicator of telogen effluvium. The average person with healthy hair follicles will shed between 50 and 100 hairs daily, but the increase in hair shedding during telogen effluvium can result in more than 300 strands of hair shed on the head.
Common causes of telogen effluvium include chronic or emotional stress, serious illnesses, childbirth, extreme dieting or weight loss, medication, illness, nutritional deficiencies, withdrawal of hormonal therapy, or surgery. Thankfully, telogen effluvium is a temporary hair loss that does not lead to baldness. Though the initial hair loss can last several months, many patients find that their hair volume and health will return to what they were before the hair shedding began after the stressor was removed. Nevertheless, this natural regrowth can be arduous, as hair typically grows about a half inch in length per month. Additionally, telogen effluvium can expose other subtle hair loss issues, such as female pattern baldness, and can, in rare cases, lead to further hair thinning or chronic hair loss. For this reason, it’s best to treat hair loss due to telogen effluvium when symptoms are visible to restore the health of the hair follicles as they re-stimulate hair growth within the natural hair cycle.
Acute telogen effluvium lasts fewer than six months, and your hair loss tends to happen two to three months after a stressor or change to your body. In 95% of cases, acute telogen effluvium goes away (resolves).Chronic telogen effluvium lasts longer than six months. It affects your entire scalp and may not have a clear cause. You may lose your hair in handfuls during the early stages of chronic telogen effluvium, but it won’t cause total baldness.
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Alopecia areata is another type of stress-related hair loss that occurs when the immune system attacks the hair follicles, resulting in patchy hair loss. Alopecia areata is an autoimmune disease during which the immune system starts to attack the hair follicles, leading to increased hair loss. Alopecia areata is often triggered by stress and leads to unpredictable hair loss in circular, non-scarring patches along the scalp.
Alopecia areata affects patients from adolescence well into adulthood and typically is indicated through patchy hair loss, with bald patches that are typically about the size of a quarter. It can be triggered by various factors, including genetic predisposition and stress, and sometimes progresses to complete hair loss on the head. The hair may go through phases of regrowth and hair loss over an extended period. In rare cases, alopecia areata can lead to hair loss all over the body, known as alopecia totalis.
Trichotillomania, while less common, is a stress-related hair loss disorder characterized by a strong urge to pull out one’s hair. Trichotillomania is a hair-pulling disorder that can lead an affected person to break off, pull out, or twist out hairs from the head, eyelashes, eyebrows, and the chin, chest, leg, or underarm regions of the body. Patients may experience relief from emotional stress following an episode of hair-pulling and have difficulty ceasing the behavior.
Trichotillomania is classified as a mental disorder along the spectrum of obsessive-compulsive disorder that affects the patient’s daily life and leads to a noticeable amount of hair loss. Trichotillomania is thought to be caused by various biological, behavioral, and psychological factors, and there is an increased risk of trichotillomania found in patients with a relative suffering from the condition. It is often linked to other psychiatric conditions, including but not limited to depressive disorders, excoriation, and Tourette’s syndrome. Trichotillomania often develops in adolescents and can continue until adulthood, affecting around 1-2% of the population. As the visible symptoms of trichotillomania often resemble alopecia areata or telogen effluvium, a psychologist or a veteran dermatologist must diagnose the condition.
Stress-related hair loss typically begins two to three months after a significant stressor or stressful event. Once feelings of stress are under control, hair shedding may continue for up to six months or, in some cases, continue for years. Stress-related hair loss is usually not permanent for everyone who experiences it; however, practicing stress management techniques and consulting with a board-certified dermatologist can help stop hair loss.
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After experiencing hair shedding or balding from stress, many patients ask, “Will hair loss from stress grow back?” The degree to which the hair grows back will depend on the hair loss type. For most patients, hair will regrow after the stress is removed. Patients often find that their hair can be restored to its former glory, although it can take many months for the hair loss to cease and hair growth to begin.
A combination of topical therapies, oral medication, and platelet-rich plasma injections is often best to treat stress-related hair loss and improve hair health, density, and growth.
Platelet-rich plasma (PRP) injections are one of the most popular in-office treatment options for hair restoration. PRP is an innovative, in-office treatment that relies on your body’s growth factors and nutrients to stimulate healthy hair follicles and produce new hair growth. PRP is derived from a sample of the patient’s blood, which is placed safely in a centrifuge to create a concentrate rich in growth factors such as Platelet-Derived Growth Factor, Transforming Growth Factor Beta, and Epidermal Growth Factor, among others. These growth factors can boost blood vessels, cells, and skin regeneration and growth, nourishing and supporting the hair follicle. Typically, a treatment session for PRP hair restoration takes around a half hour, and patients can resume regular activity after the procedure. Most patients require an initial short series of four treatment sessions, each spaced approximately one month apart, to achieve optimal results. Patients often engage in maintenance sessions to enhance treatment results and restore their hair to its former glory.
Intralesional corticosteroid injections are the most effective method for treating bald patches due to alopecia areata. Corticosteroids are anti-inflammatory medications that prevent the immune system from attacking hair follicles. During treatment, the corticosteroids are injected directly into the individual bald patches. Treatment is not painful, and patients can resume their daily activities immediately afterward. Intralesional corticosteroid injections have proven to be an incredibly effective treatment option for alopecia areata, with clinical studies reporting that 71% of patients experienced hair regrowth just 12 weeks after intralesional cortisone injections. Patients often require several treatment sessions spaced three or more weeks apart for optimal hair regrowth.
Topical treatments for hair loss can be essential in preventing new loss and stimulating hair regrowth. Minoxidil is the only FDA-approved topical treatment for combating hair loss and can help regenerate new hair. Minoxidil is available over the counter as a solution or foam base, which should be applied to the scalp at bedtime. Minoxidil can complement PRP hair treatments or oral medications and can be used long-term to sustain the results achieved from PRP.
Some of the most commonly prescribed oral medications for hair loss include:
Most baldness is caused by genetics (male-pattern baldness and female-pattern baldness). Be gentle with your hair. Use a detangler and avoid tugging when brushing and combing, especially when your hair is wet. A wide-toothed comb might help prevent pulling out hair. Avoid harsh treatments such as hot rollers, curling irons, hot-oil treatments and permanents. Stop smoking. If you're being treated with chemotherapy, ask your doctor about a cooling cap.
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