Stress, Hair Loss and How you can Take Control

Understanding Hair Loss from Stress

It is easy to let things get on top of us. Over the past 2 years the pandemic has led to a work from home culture which, for many reasons, is appealing. And while this is convenient for most, a home working environment is not always conducive to respecting the boundaries between work and personal life. Perhaps it makes it harder to switch off and say ", shouldn't I take a break?"

The financial pressures that have come with life being put on "hold" 2 years for have also been an added burden with streamlining of businesses and increased pressure to perform skyrocketing stress levels to an absolute high.

How Does Stress Impact Your body?

The effects are far reaching and can be better understood if we examine all aspects of bodily function.

Stress and Memory

The effect of stress on the brain can vary in different individuals and is dependent on variables such as the level of stress and the timing. It is theorised that low levels of stress improve cognition; this is the brains ability to perceive and interpret certain stimuli and is integral to the learning process. However, when stress levels go beyond a certain threshold, this impairs the brain's ability to process, learn and make decisions, as stress hormones directly inhibit these functions in certain parts of the brain such as the prefrontal cortex and hippocampus. (1) It is important to bear in mind that everyone's stress threshold is different, so we do not all respond in the same way to a particular stressful event.

Stress and Mood

High stress levels have a negative effect by reducing the levels of Brain Derived Neurotrophic Factor (BDNF) in the parts of the brain such as the limbic system that regulate mood. This is a growth factor that is integral to the functioning of healthy brain cells. (2)

Stress and the Immune System

Noradrenaline and Adrenaline are catecholamines. These are hormones that rise in acute stress and are responsible for the "fight or flight response", a survival mechanism which primitive man would have needed to escape predators or natural disasters, and which can still be important for survival in today's world. In studies raised levels of Noradrenaline have been shown to impair the function of white blood cells that are the body's defence against invading bacteria and viruses. (3) This is also the case with cortisol, a hormone that is elevated in chronic stress. In addition, stress hormones such as cortisol have receptors in different tissues of the immune system and can directly affect its functioning.

Stress and Cardiovascular Disease

Stress hormones affect the heart by increasing heart rate and blood pressure. The INTERHEART study, which included a sample of approximately 25,000 people from more than fifty countries showed that individuals with chronic daily stress had more than twice the risk of developing a heart attack. (4)

A meta-analysis, which examines data from many different studies has also shown there to be a link between chronic stress and an increased risk of stroke. (5)

Stress and the Gut

Stress hormones have a direct effect on absorption of food from the gut, the contractility of the gut and acid secretion. It delays emptying of the stomach and causes increase contractions of the intestines, exacerbating symptoms of Irritable Bowel Syndrome, IBS. Studies have shown a link between stress, IBS, gut inflammation, and stomach ulcers. (6)

Stress and the skin

Stress has been implicated in the exacerbation of a variety of skin conditions such as eczema, psoriasis and even acne. The relationship between stress hormones and the skin is complex, with skin having both receptors for stress hormones but also producing its own precursors to stress hormones which exhibit a wide range of effects.

Stress and Hair Loss

Losing hair from stress is commonly reported, with resolution of stress often improving the situation. Hair moves through three phases, a growth phase (anagen) lasting 3-6 years, a transitional phase (catagen) lasting 2-4 weeks and a resting phase (telogen) lasting 2-4 months, after which the hair is shed. All the hairs on a person's head are at different stages of this cycle, so that only 10% would be at telogen at one time.

A stressful event can move many hairs into the Telogen phase all at once, which leads to significant shedding of hair 2-4 months later, a condition known as Telogen effluvium. A significant psychological stress can be enough to trigger stress related hair loss, or the event could be more tangible such as childbirth, an operation, or marked weight loss.

How Stress Impacts Your Hair

Losing hair from stress can also occur for other reasons. In studies with mice, stress hormones such as cortisol have been shown to push hair into an extended resting phase (anagen). In addition, hair growth is dependent on stem cells, which are in located in the hair follicle. These are integral to the formation of new hair and need to be activated before they can perform this function. Cortisol acts to prevent the activation of these stem cells. (7)

There can be other types of stress hair loss. Trichotillomania is a condition when hair is deliberately pulled out due to psychological reasons such as stress, boredom, or tension.

Alopecia areata is a condition whereby your body attacks its own hair follicles. It usually results in discrete patches of hair loss which if, isolated and small, should fully recover within 12-18 months. High stress levels have been associated with this condition.

Will Stress Related Hair Loss Grow back?

This depends largely on the cause. The rapid shedding of hair that occurs in Telogen Effluvium usually recovers spontaneously with time, as does Alopecia areata. Other patterns of hair loss such as Male Androgenetic Alopecia (MAA) are more progressive, with thinning of hair from the temples and crown in a characteristic pattern.

Tips to Combat Hair Loss from stress

If you are interested in medical treatment for hair loss, speak to a pharmacist today, for advice on which products may help you.

Tackle Your Stress by Using Relaxation Techniques

Meditation

Mindfulness mediation involves focusing on your breathing, clearing the mind to eliminate the constant stream of jumbled thoughts that many of us are plagued by because of our busy lives. Its easy to perform and no special equipment is needed, there are plenty of online resources and apps available such as "Headspace" for example.

Journaling

This is also a form of mediation. It can be useful during times when you feel your mind is overrun with thoughts, jotting some of them down can be a useful reflection. There are no real rules, but if you do not know how to start, it helps to utilise prompts e.g. "Things that made me smile today". Many mediation journals are accessible online and have useful prompts.

Exercise You Love

Exercise is important for cardiovascular fitness, boosting memory and concentration and has been proven in studies to improve mood in depression more effectively than placebo (8). Improving mood and reducing stress levels is a vital step to improving stress related hair loss.

How to Encourage Hair Growth

As well as managing stress levels there are other steps you can take

Supplements

Vitamins have an important role in reducing hair loss. Iron, Vitamin D, Zinc and B vitamins all have a role to play particularly in conditions such as Telogen Effluvium and Alopecia Areata.

Healthy Diet

Eating a balanced diet with enough essential nutrients, keeping hydrated and getting plenty of sleep are all vital to prevent hair loss. If you feel your diet is lacking, speak to a pharmacist today about Perfectil or other hair supplements.

Hair loss treatments

Minoxidil -topical solution 2% or 5%

It is thought to work by increasing the anagen(growth) phase of hair.

It may need to be applied twice daily for at least 3-4 m months before the effects are realised. Continued application is needed to maintain the hair growth, otherwise the newly grown hair may be shed within a few months. A recent study found that the 5% Minoxidil solution was superior at improving hair growth than the 2% in men with MAA. (9)

Regaine is the most common, branded version of Minoxidil and is sold in a 5% solution for men and 2% solution for women.

Finasteride

This is taken in a tablet form and blocks the effect of testosterone on hair follicles in men with MAA, which contributes to shortening of hairs and thinning from the crown and temples.

Finasteride has been proven in trials to slow hair loss and improve hair growth. (10)

Dutasteride is another medication that works in much the same way as Finasteride to combat hair loss in men.

It is important to know that medical treatments can take up to 4 months to start working. Once effective, the treatment should delay the progression of hair loss. If stopped, the benefits will be lost after 6-12 months of no treatment, with rebound shedding of hair sometimes occurring. Essentially, if the treatment is effective, it will need to be taken indefinitely to not lose the benefits.

Propecia is the branded version of Finasteride, both have the same active ingredient.

Other treatments

Alpecin C1 Caffeine shampoo

Caffeine shampoos, such as Alpecin C1 Caffeine Shampoo, have shown to be a promising treatment with reported increases in hair thickness and strength.

Related Items:

1. Hair Loss Guide
2. What causes Hair Loss
3. What you need to know about hair loss in women.
4. Hair Loss: Questions and Answers
5. Hair Loss myths

References:

1. Sandi C. Stress and cognition. Wiley Interdisciplinary Reviews: Cognitive Science. 2013;4:245–261. [Google Scholar]
2. A Neurotrophic Model for Stress-Related Mood Disorders. Ronald S Duman Lisa M.Monteggia
3. 88. Reiche EMV, Nunes SOV, Morimoto HK. Stress, depression, the immune system, and cancer. Lancet Oncol. 2004;5:617–6 [Google Scholar]
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5. Booth J, Connelly L, Lawrence M, Chalmers C, Joice S, Becker C, et al. Evidence of perceived psychosocial stress as a risk factor for stroke in adults: a meta-analysis. BMC Neurol. 2015;15:233 10.1186/s12883-015-0456-4. [Google Scholar]
6. Konturek PC, Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. J Physiol Pharmacol. 2011;62:591–599. [PubMed] [Google Scholar]
7. Corticosterone inhibits GAS6 to govern hair follicle stem-cell quiescence Sekyu Choi et al Nature 2021 Apr;592(7854):428-432. doi: 10.1038/s41586-021-03417-2. Epub 2021 Mar 31.
8. Cochrane Database Syst Rev 2013 Sep 12;(9):CD004366. doi: 10.1002/14651858.CD004366.pub6. Exercise for depression Gary M Cooney 1, Kerry Dwan, Carolyn A Greig, Debbie A Lawlor, Jane Rimer, Fiona R Waugh, Marion McMurdo, Gillian E Mead
9. Clinical Trial J Am Acad Dermatol 2002 Sep;47(3):377-85. doi: 10.1067/mjd.2002.124088. A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men Elise A Olsen 1, Frank E Dunlap, Toni Funicella, Judith A Koperski, James M Swinehart, Eduardo H Tschen, Ronald J Trancik
10. Clinical Trial J Am Acad Dermatol 1998 Oct;39(4 Pt 1):578-89. doi: 10.1016/s0190-9622(98)70007-6. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group K D Kaufman 1, E A Olsen, D Whiting, R Savin, R DeVillez, W Bergfeld, V H Price, D Van Neste, J L Roberts, M Hordinsky, J Shapiro, B Binkowitz, G J Gormley

Authored on 01 June 2022

Nisha Wariyar - BSc MBBS MRCP MRCGP

Medical Content Writer

GMC Number: 6054737

Reviewed on 03 June 2022

Stuart Gale - BSc (hons) MRPharmS

Superintendent Pharmacist and Owner

GPhC Number: 2039889