Can stress cause hair loss? Duh!

One day I had a patient come in with a worried look. She complained of sudden, severe hair loss and mentioned that she had been stressed at work. I prescribed her some vitamins and gave her some tips for managing stress. But as I was walking her out, she asked, "Doctor, will my hair grow back on my head or somewhere else?" I couldn't help but chuckle and reassure her. As I watched her walk away, I couldn't help but wonder what other strange and humorous cases the world of dermatology had in store for me.

Well, as evident, stress invariably causes hair loss. But before we delve into the relationship between stress and hair loss, first let me walk you through the types of stress that can affect our hair.

What qualifies as stress?

1. Emotional stress

The most important form of stress responsible for hair loss is emotional stress. Though an isolated stressful day or just a week might not trigger hair loss, a state of prolonged emotional stress lasting for weeks to months can pose a significant risk. Life-altering events (like divorce or morbid grief), endogenous or exogenous depression, or prolonged severe stress (for instance, COVID-19 pandemic-related anxiety) are key triggers.

2. Physical stress

Similarly, episodes of severe physical stress like being bedridden, paralyzed, prolonged hospitalization, childbirth, or an untreated chronic illness (thyroid disease, diabetes) can also trigger hair loss.

How does the normal 'hair cycle' work?

An adult individual's scalp contains around 100,000 hair follicles. Every follicle goes through continuous cycles which consist of stages of growth (anagen), transition (catagen), and rest (telogen). At any given point, approximately 90% of follicles are in the anagen, 1% are in catagen, and up to 9% are in telogen. Telogen is the stage of hair shedding.

Although it is normal to lose up to 100 hair per day, in cases of chronic or severe acute stress, this hair loss might be dramatically high. There is a sudden shift of a large number of hair follicles (between 25% to 50%) from anagen to telogen due to stress. This abnormal state of abrupt transition from anagen to telogen is known as 'telogen effluvium'.

Telogen Effluvium - The vicious cycle of stress and hair fall

In telogen effluvium, there is an active shedding of more than 100 hair per day. However, one important point to be remembered here is that it takes the hair around 2-3 months to start falling after the hair follicle enters the stage of telogen. Therefore, often stress-induced hair loss would start around two months after the onset of a severely stressful event in life.

Once telogen effluvium sets in, the affected hair can fall out on its own, or while washing and combing it. Unlike other forms of alopecia (scalp hair loss), there is diffuse thinning of hair in telogen effluvium.

The cosmetic concerns posed by incessantly falling hair further aggravate the state of mental stress, thereby, fostering the telogen effluvium even more. Thus, it sets in the vicious 'stress-hair-loss-cycle'.

Is telogen effluvium permanent?

No, telogen effluvium is not a permanent form of hair loss. Since there is no destruction of the hair follicles, the affected hair can grow back once the inciting factors are removed.

Just as all grief and sorrow lessen with time, so does stress-induced hair loss.

Generally, it takes anywhere less than 6 months for the hair shedding to stop. Although, it may take months to years for the hair to regain its original length. The hair growth in the post-effluvium stage is often sluggish.

How to prevent telogen effluvium?

Sadly, an episode of telogen effluvium cannot be prevented or halted by any (proven) remedy. The episodes invariable take their natural course and resolve on their own in due course of time.

How to treat telogen effluvium?

Since hair is largely made up of a protein called keratin, a balanced diet rich in proteins is a good dietary measure for healthy hair. The recommended protein allowance per day is 0.8 grams per kilogram of body weight.

Additionally, one must avoid unhealthy hair habits, which promote the breakage of hair strands, like chemical-based hair treatments, repeated hair dying, heat-based hair styling, and tying the hair tight.

Practicing coping strategies, especially meditation, can help you be attentive to your mental and emotional health. Bringing small changes in your lifestyle can significantly impact the health of your hair and overall body.

Acute hair loss could indicate an internal illness requiring medical attention. If you are noticing sudden, diffuse, or patchy hair loss, you must consult your dermatologist at the earliest.

Treatment options include oral nutritional supplements, vitamins, and minerals daily or as cyclical therapy. Injectable PRP (platelet-rich plasma) is also a promising therapy. You can also try topical medications like Minoxidil or Redensyl for hair.

In the end, I would just like to say that while hair loss can be induced by stress, try not to induce stress due to hair loss.