Stress Related Hair Loss: Why Pandemic Stress Might Mean Losing Some Hair

June 30, 2020

Woman with stress related hair loss

During the coronavirus (COVID-19) pandemic, people have had a lot of stress to manage, changes to navigate, and life challenges to overcome. It’s no surprise that many people been suffering from a range of stress-related skin conditions. According to Dr. Juliet Gibson of U.S. Dermatology Partners affiliate office Trinity Dermatology in Carrollton, Texas, “Stress can take a toll on the body. During stress, a perceived threat causes the body’s ‘fight or flight’ response to shift energy away from areas it considers non-essential until that threat has resolved.  When you’re stressed, you may notice that your skin and nails look less healthy.  You may also find yourself losing hair.”  In this blog, Dr. Gibson will walk through what stress-related hair loss is, why it happens, and how you can prevent long term hair loss.

What is Stress-Related Hair Loss?

According to Dr. Gibson, “When we talk about stress-related hair loss, we are usually talking about a disease called Telogen Effluvium which causes diffuse shedding of hair.  This can be precipitated by a variety of stressors on the body including surgery, hormonal changes, medications, poor nutrition, and psychological stress.  Stress can also lead to worsening of other types of hair loss.”

Telogen Effluvium

Hair grows in cycles, so understanding how hair grows can help you to understand stress-related hair loss. There are four phases of the natural hair growth cycle:

  • Anagen – This is the growing phase and it lasts between two and seven years. People who struggle to grow their hair out likely have shorter anagen cycles.
  • Catagen – This is the shortest phase of the hair growth cycle. During catagen, the follicle shrinks in preparation for the next part of the cycle.
  • Telogen – This is the resting period where hair does not grow. It usually lasts a few months.
  • Exogen – This is when hair is shed in preparation for new, healthy hair growth.

According to Dr. Gibson, “In telogen effluvium, all hair follicles are shifted into telogen, the resting phase, where new strands are unable to continue to grow and instead there is massive hair shedding usually 3-5 months later.  With this shedding, hair begins to look thinner or patchy.”

Other Types of Hair Loss That May be Impacted by Stress

Alopecia Areata

Alopecia is the technical term for hair loss. There are many different types of alopecia, including androgenic alopecia (male and female pattern baldness), and alopecia areata, which is hair loss caused by immune system dysfunction. Like telogen effluvium, alopecia areata can lead to hair that looks thin or bald spots. While research is unclear on the direct cause of alopecia areata, many patients find that stress worsens the disease.

Androgenetic Alopecia

We all lose some hair as we age which is known as pattern hair loss or androgenetic alopecia. In men, hair is lost in a well-defined pattern, beginning above both temples. Hair also thins at the crown near the top of the head, often progressing to partial or complete baldness. The pattern of hair loss in women differs from male-pattern baldness. In women, the hair becomes thinner all over the head, and the hairline does not recede. According to Dr. Gibson, “Many people have a combination of types of hair loss.  For example, telogen effluvium will lead to massive shedding of hair, and in certain patients, this can unmask underlying androgenetic alopecia.  Understanding both types of hair is important in creating a successful treatment plan.”

Trichotillomania

You may have heard someone jokingly say that stress is making them pull their hair out, but for those who suffer from trichotillomania, this uncontrollable urge to pull at hair is no joke. As a result of stress, many people develop an unconscious hair pulling, twisting, or tugging habit that can lead to hair loss. It most often impacts teens and adolescents, but the habit can continue into adulthood. While this condition mostly involves pulling at the hair on your head, it may also include pulling at facial hair (eyebrows, eyelashes, beard, etc.) and hair on other parts of the body (arms, legs, etc.). In most cases, the hair-pulling happens when individuals are stressed or distracted, and many people don’t even notice that they’re doing it. According to Dr. Gibson, “Trichotillomania can be a vicious cycle. Many times, people don’t notice they’re pulling at their hair. Then, when they do notice or see hair loss as a result of this condition, it triggers additional stress, which leads to increased pulling at the hair. Treatment for this condition may involve working with mental health professionals as well as addressing the hair loss.” Unlike telogen effluvium, which can cause thinning hair or patches of hair loss, trichotillomania leads to hair loss in the specific areas where the patient is pulling or tugging at their hair and nowhere else.

How Can I Prevent Stress-Related Hair Loss?

Like many other skin conditions, prevention can go a long way toward keeping you looking and feeling your best. According to Dr. Gibson, “Many people have experienced abnormally high levels of prolonged stress due to issues surrounding COVID-19. From job loss or instability to general fear about contracting the virus, this has been a challenging time. It’s no surprise that people are really stressed. I know it’s easier said than done, but the first step to prevent further hair loss and start healing from stress-related hair loss is to start reducing stress.” Some great ways to relieve stress and feel better include:

  • Limit your time spent watching or reading about COVID-19 and engaging with other stressful situations that you have no control over.
  • Practice relaxation techniques like mindful breathing and meditation.
  • Exercise can help increase endorphins (the feel-good chemicals) in the brain, which is great for stress relief. Consider doing yoga to combine the endorphin rush of exercise with the relaxation of meditation.
  • Don’t isolate. Even if you’re not ready to spend time in big groups of people or public places, call to check in with friends and family, chat over text, or schedule a video conference with friends. Simply talking to other people who are experiencing similar situations can help you feel a little better.
  • Make time for hobbies and pastimes that make you happy and help to reduce stress. Read a book, watch your favorite show, or play board games with family.
  • You are what you eat so it stands to reason that a healthy diet can help with stress too. When we’re stressed, the body needs extra nutrients to continue functioning at the highest level. Eating a healthy, nutrient-dense diet can ensure that your body receives the fuel it needs to stay healthy. To boost hair regrowth, make sure you’re getting plenty of Vitamins C, B, and E, which are essential to skin and hair health.
  • Stay hydrated to ensure cellular health. Every cell needs water to function, so make sure you are drinking between eight and ten cups of water every day.
  • Get plenty of sleep. During the night, our bodies heal and replace damaged cells, but without adequate sleep, your body doesn’t have time to renew itself.
  • If you’re experiencing very severe stress, consider talking to a therapist who can help you develop skills to manage stress and improve resilience during times of increased stress. Working with a mental health professional is central to the treatment of trichotillomania.

Is Stress-Related Hair Loss Permanent?

According to Dr. Gibson, “Luckily, most cases of stress-related hair loss are not permanent. By reducing stress and addressing the hair loss with at-home solutions and professional treatments from your dermatologist, you may be able to achieve complete hair regrowth, but the process can take some time.” If your hair loss is entirely related to telogen effluvium, you should be able to regrow your hair, but the process can take several months.  For many who also have a component of androgenetic alopecia, hair loss will not completely recover without additional treatments.

What Treatments Are Available for Stress-Related Hair Loss?

The first step to successfully treat stress-related hair loss will be a consultation with an experienced dermatologist. Your dermatologist will test for factors that are associated with telogen effluvium such as Vitamin D deficiency, thyroid abnormalities, or iron deficiency, and will create a custom treatment plan that addresses these factors as needed. There are numerous effective treatments available to address all types of hair loss, including stress-related hair loss. Your treatment plan may include oral and topical medications, laser treatments, injections, or even hair transplants.

Prescription & Over the Counter Medications

Depending on the underlying causes of your hair loss, we may prescribe or recommend taking over the counter hair growth medications. Minoxidil (Rogaine) has been used successfully by prescription for several decades, and it’s now available over the counter in the form of medicated creams, sprays, and foams.  It is primarily used as a long-term treatment for androgenetic alopecia but it can also be used for telogen effluvium. When used appropriately, minoxidil can stimulate new hair growth, prolong the anagen phase of the hair growth cycle, and help to prevent further hair loss.  Most people will need to continue using minoxidil periodically as recommended by their dermatologists to prevent additional hair loss, but for those whose hair loss is connected to stress, pairing short term minoxidil application with stress relief plans is typically effective to regrow and maintain results.  For cases of telogen effluvium that unmask underlying androgenetic alopecia, we may also recommend finasteride (Propecia) or spironolactone to help with hair loss. For alopecia areata, medications that modulate the immune response can be helpful and include topical immunotherapy and topical and oral tofacitinib. A board-certified dermatologist can discuss the risks and benefits of these treatments with you.

Corticosteroids

Both topical and injected corticosteroids can be an effective treatment for alopecia areata and certain cases of telogen effluvium.

Platelet-Rich Plasma (PRP) Therapy

A relatively new treatment option, platelet-rich plasma (PRP) therapy is an effective solution for hair loss in both men and women. The process involves drawing a small amount of your blood, then placing the blood into a centrifuge that separates it so we can draw out just the plasma. Plasma contains proteins and antigens that promote health, and when injected back into the scalp as part of PRP therapy, plasma has proven effective in promoting hair regrowth. From drawing blood to injecting the plasma, the entire PRP therapy process only takes fifteen to thirty minutes. There is no recovery or downtime necessary. In most cases, patients attend PRP hair loss treatments over three to six months. In the early weeks and months of treatment, you should notice that hair loss slows. Then, you should begin to see hair regrowth. Like other hair regrowth treatments, PRP therapy may also be effective in stimulating continued hair growth for those who wish to grow their hair longer.

How U. S. Dermatology Partners Helps with Hair Regrowth

If you’re struggling with stress-related hair loss, the U.S. Dermatology Partners team is here to help. Our locations are now reopened for non-emergency in-office visits. So, if you’re interested in treatment for stress-related hair loss, you can start by scheduling your treatment consultation using the appointment request form on our website. Once we receive your information, one of our team members will be in touch to discuss the details of your visit.

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