Stress-Induced Hair Loss – NYC Dermatologist

NYC dermatologist Novick, Nelson

By Nelson Lee Novick, MD

New York, New York 10028

Physician (MD, DO), Cosmetic Dermatology, Dermatologic Surgery, Dermatology


One ordinary day, you, who all your life has sported a thick, rich head of hair, are standing there in your shower merrily lathering it up when low and behold out come batches of it right into your hands. Instinctively you turn to look down toward the drain by your feet, and to your horror, you discover a thick wad of your hairs stopping it up. In another scenario, you wake up one fine morning to find large mounds of hair all over your pillow, and when you brush equally alarming amounts seem to come out with each stroke.

Whichever the case, the next thing you know, you’re sitting on the edge of your seat in the dermatologist’s office with a plastic bag full of the hair you’ve collected from just about everywhere panicked about going totally bald. Sounds like something out of one of your worst nightmares? Well, it’s a reality for the thousands of individuals each year who suffer from telogen effluvium, otherwise known as stress-induced alopecia (hair loss).

Stress-induced hair loss is so named because a variety of physical and emotional stresses have been known to precipitate it. These include a whole laundry list of medical and psychiatric conditions. Among the more common triggers are high fever, severe infections (even severe influenza) metabolic diseases (eg. thyroid disease, crash dieting, anemia), autoimmune diseases (like systemic lupus erythematosis, ulcerative colitis, rheumatoid arthritis), delivery-related, major surgery, acute blood loss, trauma, and emotional conditions, such as relationship breakups, loss of work, acute anxiety disorders, serious depression, and schizophrenia. Whatever the cause, stress-induced alopecia is characterized by sudden hair loss that occurs diffusely throughout the whole scalp, including an often prominent recession in the temporal areas.

Although the exact physiologic mechanisms involved in telogen effluvium are not known, some researchers believe the condition may in some way be related to shifting concentrations of androgens and estrogens (male and female hormones). Others maintain that inflammation of the hair follicles plays a role. Whatever the exact mechanism, we do know that the normal hair cycle is altered and that large numbers of actively growing hairs (known as anagen hairs) are shifted suddenly into the resting phase known as telogen.

In an otherwise healthy individual, about 80 percent of hairs are actively growing and the remainder are in the resting stage poised to fall out gradually. However, in stress-induced hair loss, as many as 40 percent of hairs may be shifted suddenly into telogen, an event very similar to what occurs prior to the molting phase seen in lower animals.

Regardless of the antecedent causes, once this sudden shift has taken place, the subsequent chain of events is fairly characteristic. The prematurely shifted hairs will remain in the resting phase until the next normal physiologic growing cycle, which usually occurs on average about three months later. It is then, when the new, actively growing hairs begin pushing up on the resting hairs, that the the major “molting” occurs– a process which may last for another one to three months. The several month delay between the original stressor and the onset of the hair loss often explains why sufferers do not necessarily make the connection on their own.

Occasionally telogen effluvium evolves into a chronic (long-term) disorder. In such cases, after an extended passage of time, the link between the original stressor and the hair loss may become even less obvious. The majority of individuals who suffer from this condition, known as chronic telogen effluvium (CTE), are middle aged women. It is not surprising that in other instances of CTE, protracted shedding relates to the ongoing nature of a particular underlying chronic medical or emotional illness.

The history of sudden, profound hair loss a few months after a severe physical or emotional stress is all that is most often necessary to arrive at the correct diagnosis. Happily, the vast majority of sufferers of all kinds of stress-induced hair loss can be reassured that they are not going to go completely bald. In fact, they can expect to regrow all or nearly all of their hair within several months, so long as the precipitating cause is no longer present or has been adequately treated.

Although most cases of telogen effluvium resolve spontaneously without therapy, some physicians have recommended the use of a short course of topical or oral steroids to reduce any inflammation and thereby speed hair regrowth. More commonly, topical minoxidil (Rogaine) is used to shorten the course of the disorder by accelerating the generation of new anagen (growing) hairs.  In the final analysis, simple reassurance that the pelage will likely return to its former glory is probably the best of all remedies.