Androgenetic (androgenic) alopecia (AGA) is the most common hair loss disorder in both men and women. It is usually seen as a relatively mild dermatologic condition. But many patients with this problem really believe that this is a serious disease that puts them under stress and significantly impairs their quality of life. However, it is supposed that not only can hair loss be stressful, but vice versa – the stress itself can lead to hair loss. Is that true?
Stress & mice
Previously, data on the negative effect of stress on the hair follicle were obtained in a mouse model – studies have shown that exposure to stress has a pro-inflammatory effect and promotes the transition of hair from anagen (growth phase) to catagen (rest phase preceding the hair loss phase). It is also believed that the hair follicle itself can produce a sufficient number of stress mediators and express the cognate receptors, which in turn can directly contribute to hair loss (Arck PC et al, 2001, Arck PC et al 2003, Slominski A et al 2000). Stress & humans Hair loss can be a serious problem for humans, the problem that often not only aesthetic but also psychoemotional and even psychosocial. In order to solve this problem, people use various strategies (so called coping strategies – to cope with stress and psychological problems), which, on the one hand, are not always effective, and on the other – are not always adequate.
As an example, table 1 (Ina M. Hadshiew et al (2004), modified after Schmidt et al (2001) presents coping strategies for diffuse and androgenetic alopecia.
Table 1. Coping strategies for diffuse and androgenetic Alopecia
Ina M. Hadshiew et al 2004, modified after Schmidt et al (2001).
Stress and hair loss
Najmossadat Atefi et al (2006) conducted a study to determine the relationship between stressful events in the lives of individuals and unexplained [from the point of view of other causes] diffuse telogen hair loss. The authors found that stressful situations (mainly events with a moderate to high stress level) can be considered as a significant risk factor for hair loss.
S Tabolli et al (2013) assessed the overall health status, risk of anxiety/ depression, severity of *alexithymia, and strategies for coping with stress in patients with AGA.
What have they revealed?
Anxiety/ depression in AGA patients
The study confirmed the presence of high levels of depression/ anxiety in patients with AGA. Attention is drawn to the fact that compared to men with androgenetic alopecia, women with AGA had a significantly higher level of depression and/or anxiety, it was as high 60% (!).
In addition, the researchers noted an interesting fact – the perception of the problem in patients with androgenetic alopecia depended not so much on the actual clinical picture (!), but rather on their emotional state and psychological status (!).
In their work published in 2013 S Tabolli et al (as well as Ina M. Hadshiew et al earlier in 2004) note that in order to cope with the problem, patients use various strategies for managing stress, which do not always help them cope adequately with the situation. According to research patients who experienced anxiety or depression in combination with *alexithymia, were more likely to use such coping strategies [in attempts to cope with their problem] as self-destruction, denial, behavioral and mental detachment, self-blame, substance use, and so on.
Important news for Trichology specialists
Scientists believe that specialists who work with patients suffering from hair loss diseases should be aware of the data obtained in their study. Dermatologists, trichologists should more often refer their patients to a psychologist and/or psychotherapist for further examination and for providing psychological assistance and support to such patients.
In addition, dermatologists-trichologists should be aware that the manifestations of androgenetic alopecia (as well as other trichological conditions) are not limited only to the symptoms of hair loss. These patients need help with their emotional responses to hair loss, such as anger and anxiety, and their concerns about the impact of hair condition on their appearance and social life.
• Scientists have found evidence of the negative effect of stress on hair follicle (in studies on rodents, and in humans).
• It is known that stress can trigger hair loss and/or worsen an existing problem. Hair loss can also lead to stress, as well as it has a negative impact on a person's psychoemotional state and quality of life.
• Androgenetic alopecia may negatively affect the psychoemotional state of both men and women. At the same time, patients with *alexithymia were more likely to choose maladaptive stress-coping strategies (compared to patients without alexithymia).
• Women are more vulnerable (both in terms of stress and in terms of evaluating the state of their hairstyle) than men. The problem is that the hair condition affects a woman's self-esteem and quality of life, and the feeling of her age.
• Chronic stress often remains unrecognized. It is not always noticed by specialists, it is not noticed by patients, who have already got used to this condition and do not know that it is possible to live in a different way – an active life, without anxiety, fatigue and apathy.
• Both doctors and patients need to pay more attention to the psychoemotional and psychosocial aspects of hair diseases.
• A specialist trichologist can help such a patient using methods of medicinal treatment, herbal medicine, and others.
• In case of an increased stress and anxiety level, if the patient is unwilling or unable to use the medication treatment, it is recommended to refer the patient to a psychologist or psychotherapist.
• Non-drug approaches such as physiotherapy, acupuncture can also be used.
• The use of strategies to control the level of stress and anxiety in patients not only improves their psychoemotional state and well-being, but also (in some cases-significantly!) increases the effectiveness of hair diseases treatment.
Natalie Barunova, MD,
Dermatologist – Trichologist, specialist in Nutrition & Dietetics, Medical Acupuncture
* Alexithymia is a subclinical phenomenon involving a lack of emotional awareness or, more specifically, difficulty in identifying and describing feelings and in distinguishing feelings from the bodily sensations of emotional arousal. Alexithymia is considered a risk factor for psychosomatic diseases.
* Dysmorphophobia, also known as body dysmorphic disorder (BDD), is a psychiatric disorder characterised by fixation on an imaginary flaw in physical appearance. Although it is a psychiatric illness, most patients do not acknowledge this and seek help from cosmetic surgeons and dermatologists. In the dermatological setting the condition has been termed dermatological hypochondriasis.