STRESS AND ITS BAD EFFECT ON HAIR LOSS

Traumatic events, work deadlines, physical conditions, chronic illness, raising a family, fight with a loved one, social condition such as poverty or discrimination and currently the lockdown situation due to the COVID-19 pandemic, are all stresses that the active, contemporary and fashionable woman is facing and living within our present time. 

People under stress experience mental as well as physical symptoms, such as tension and irritability, fear and weakness, fatigue and muscle pain, digestive disorders and sleeping disturbances mainly insomnia, poor sleep quality or early awakening.

Also, stress has long been implicated as one of the causal factors involved in hair loss. Even more, once stress is one of the hair fall reasons and maintenance factors, some cases tend to become chronic, due to the stress and concern caused by the hair loss itself. All this would generate a vicious cycle that is very difficult to break; therefore, the importance of resorting very early to radical and long-lasting solutions. 

On March 26, 2020, Time Magazine reported that the coronavirus pandemic may be causing an anxiety and emotional pandemic. This will definitely have its toll on stress as well as physical and mental conditions that are stated above. Actually with the lockdown status that most countries are observing, the stress created by the pandemic could be of the worst generated ones. 

While many activities would help individuals overcome the encountered stress, the solution starts by “being kind to yourself”, but that is way more easier said that done. Get plenty of sleep (7-8 hours a day), drink and eat healthy, avoid too much sugar and caffeine, try to exercise regularly even in confinement, take up a relaxation practice such as yoga and meditation, take longer time out for activities you enjoy, stay away from social media’s fake information, don’t get hooked to coronavirus news and go out in nature if possible. 

Now back to the influence of stress and anxiety on hair loss. In fact, many studies have shown that stress is a main culprit in two forms of hair loss: Telogen effluvium and alopecia areata. In order to understand these two conditions, let’s have a look at the normal hair growth cycle. 

The hair growth cycle consists of three stages or phases starting with hair growth and ending in hair shedding. The three stages are known as the Anagen phase, Catagen phase and Telogen phase.

The Anagen phase: It represents the stage and period of hair growth. Cells located in the hair bulb multiply rapidly creating new hair growth. This stage usually lasts between 2 to 7 years where the hair is actively growing from its roots by an average length of 45 cm to 75 cm in total before it becomes dormant and enters the catagen phase. Many factors affect this phase; genetics, lifestyle, health and chronic illnesses.

The Catagen phase: The second phase of hair growth cycle is the Catagen one. This phase is rather short, lasting only 2-3 weeks on average. In this dormant phase, the hair stops growing and loses its blood supply.

The Telogen phase: This is the final phase of the hair growth cycle. It lasts around three months at the end of which hair is shed while new hair begins to grow underneath.

It is worth mentioning that hair follicles are independent and not all the hair undergoes the whole cycle at the same time so that no broad hair patches would fall together but rather 50 to 100 hairs each day of the telogen phase. This keeps around 90% of the hair in the first anagen growth phase.

Having looked at the normal hair cycle, we can understand now how stress would interfere negatively causing hair loss. Stress has the ability to influence the balance of hormones, neurotransmitters and other substances involved in the normal growth of the hair and the health of the scalp. Also stress can increase local inflammation leading to a sick hair bulb and hence, induce a premature entry of the hair cycle into its telogen phase causing thinning of the hair and hair loss. This is known as Telogen Effluvium Condition. While telogen effluvium is the major form of hair loss caused by stress, stress can also cause another form of hair loss called Alopecia Areata. Alopecia areata is more associated with some auto-immune diseases, but it has been also observed in healthy people suffering from extreme stress.

Although hair loss is a benign medical condition it is not however far from becoming a serious one since losing hair can have very bad physical and mental health repercussions. Indeed, affected individuals experience great psycho-emotional disturbances often leading to a reduction of quality of life and secondary morbidity. 

Reduced social acceptance, sadness, feelings of helplessness, depression, reduced self-consciousness, worrying, social stress, frustration, powerlessness, fright, disgust, hate, humiliation, embarrassment, anger, shame, dissatisfaction with body image, loss of self-confidence and worthlessness, unhappy about appearance and feeling older are many of the individuals perceived negative effects of hair loss. 

Something urgent needs to be done about that in order to stop the hair shedding, restore self-person’s reassurance and break the vicious cycle of stress and hair loss.

Figure courtesy of Hadshiew IM et al. The Journal of Investigative Dermatology; 2004   

The figure up shows the vicious circle established between stress, depression, anxiety and hair loss. It also shows how physical, psychological, behavioral and pharmacological – including special food supplements –  interventions could break the vicious circle and help in restoring healthy hair and scalp.

While some advices have been given above on how to relieve one’s stress and anxiety, other interventional therapies might prove of help in preventing or managing stress associated hair loss by targeting all the causes that could perpetuate this bad condition like oxidative stress and local inflammation of the hair bulb. Also, deficiencies in certain essential nutrients for hair and scalp health should be prevented and addressed. These nutrients include minerals, vitamins and proteins like zinc, vitamin B complex and keratin. 

Zinc is an essential cofactor for multiple enzymes involved with important functional activities in the hair follicle. It is a potent inhibitor of hair follicle regression and accelerates hair follicle recovery. Zinc has also antioxidant properties that would add to its beneficial actions.

Vitamin B complex including vitamin B3 (also known as niacin), vitamin B5 known as pantothenic acid, vitamin B6 and B8, simultaneously pyridoxine and biotin, have over the years established their efficacy on preventing hair loss by improving blood supply to the scalp and hair bulb, reduce inflammation, act as antioxidants, rebuild keratin (the major protein in the hair structure) and moisturize the hair shaft.

Keratin is the major protein which is naturally present in our hair. In clinical studies, keratin given orally has been shown to decrease significantly hair loss as assessed by the hair pulling test. 

Beside keratin, curcumin is known to have anti-inflammatory effects and a mast cell stabilizer. Following stress, mast cells can release inflammatory cytokines that can badly affect skin and hair, thus the need to stabilize the mast cell release of its content. However, curcumin needs to be given in a special formulation to be well absorbed from the intestines and produce its beneficial anti-inflammatory effects locally around the hair follicle.  

In times of increased anxiety, no need for women to suffer with their beauty and worry about losing their hair. These women are invited to practice behaviors that addresses their stress and anxiety by leading a healthy lifestyle physically and emotionally. Eating healthy, keeping fit and abstaining from unhealthy daily activities have always proven to be of useful especially in days of stress. 

References:

  • Gradus JL. Prevalence and prognosis of stress disorders: a review of the epidemiologic literature. Clinical Epidemiology 2017:9 251–260
  • Kluger J. The Coronavirus Pandemic May Be Causing an Anxiety Pandemic. TIME edition March 26, 2020.
  • Ji Won Oh et al. A Guide to Studying Human Hair Follicle Cycling in Vivo. Journal of Investigative Dermatology. 2016; Volume 136, Issue 1: 34-44.
  • Ina M.Hadshiew et al. Burden of Hair Loss: Stress and the Underestimated Psychosocial Impact of Telogen Effluvium and Androgenetic Alopecia. Journal of Investigative Dermatology. 2004; Volume 123, Issue 3: 455-45
  • Ademir Carvalho Leite Junior et al. Hair loss as an expression of stress – Psychosomatic Concepts applied to Trichology. postgraduation course on Psychosomatics. Instituto Junguiano de Estudo e Pesquisa – IJEP. December, 2012
  • Trüeb RM. The impact of oxidative stress on hair. Int J Cosmet Sci. 2015; 37 Suppl 2:25-30
  • Min Seong Kil et al. Analysis of Serum Zinc and Copper Concentrations in Hair Loss. Ann Dermatol. 2013 Nov; 25(4): 405–409
  • Hoon Park et al. The Therapeutic Effect and the Changed Serum Zinc Level after Zinc Supplementation in Alopecia Areata Patients Who Had a Low Serum Zinc Level. Ann Dermatol. 2009 May; 21(2): 142–146  
  • Peters Eva MJ et al. Hair and stress: A pilot study of hair and cytokine balance alteration in healthy young women under major exam stress. PLoS ONE. 2017; 12(4): e0175904.
  • Christina Beer, Simon Wood and Robert H. Veghte. A Clinical Trial to Investigate the Effect of Cynatine HNS on Hair and Nail Parameters. The Scientific World Journal. Volume 2014, Article ID 641723, 6 pages.
  • Patricia K. Farris et al. A Novel Multi-Targeting Approach to Treating Hair Loss, Using Standardized Nutraceuticals. JDD.2017; Volume 16, Issue 11; Supplement Individual Articles-141

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