Ex Love Island star and influencer Kaz Crossley bravely opened up to her 1.1M fans via her social media platform about her recent problems with hair loss. Kaz spoke candidly about her stress and anxiety levels and the belief that these are the underlying factors contributing to her alopecia. Here Leading Trichologist Eva Proudman MIT IAT, founder of UK Hair Consultants and resident trichologist expert on Really TV’s The Hair Loss Clinic discusses the issue and how to treat the problem;
So, it there a link between stress and hair loss?
Yes, there is a definite link between stress and hair loss. Our body is very clever and is essentially a complex network of systems that all communicate and rarely operate in isolation. Stress can start out as a nagging worry and become much greater causing our physical wellbeing to be compromised from lack of sleep, a change in hormonal responses and an increase in inflammation.
As such, stress is a frequent cause in hair loss and something that I see in many of my patients – so a ‘starting point’ and indeed, a crucial part of any recommended treatment plan is to help with stress management.
Our response to stress often causes us to make unhealthy changes to our diet; such as skipping meals or opting for easy comfort foods. These can lead to a depletion in stored vitamin and mineral levels which in turn can trigger hair loss. Prolonged periods of stress can also cause an increase in the hormone cortisol - this puts our bodies into survival mode where priority is given to every essential body cell. As the hair is non-essential, this is another way that stress can cause hair loss. Finally, stress can also cause a rise in inflammation within our bodies which can trigger many different responses not least of all triggering the autoimmune system to malfunction, which again can and does cause hair loss.
Often hair or scalp problems cause an increase in our stress levels, which can in turn perpetuate or exacerbate the situation. In such cases, we endeavour to ensure that a patient understands what their condition is, and how it can be treated and managed to lower overall levels of stress and anxiety.
How does stress impact the cycle of a hair follicle?
The hair growing cycle is normally classed with four distinct phases.
Phase one; The Growing Phase Anagen. With around 85% of your hair in this stage at any one time, this phase can last between on average between 3-5 years. Some people can have slightly shorter or longer growth phases with some having up to a 7-year phase which means the hair can grow up to 3 feet long in this time. In this phase the cells in the root of the hair are actively dividing. The hair follicle is the second fastest dividing cell in our bodies but is also non-essential which is why it is so reflective of stress, diet, ill health medications and much more.
Phase two; Catagen. This is a small 10-day phase where the hair transitions from the growing stage - basically the active growth is ceased with blood supply cut off from the cells that produce the new hair.
Phase three Telogen. Around 10% – 15% of your hair should be in this stage; the follicles are not active and this phase lasts between 2 – 4 months where the now inactive hair is gradually moving up the hair shaft to be naturally shed.
Phase four Exogen. This is the final stage where the individual hairs fall out. Every day we can shed anywhere between 50 – 150 hairs. A new hair pops out after the shed hair and renters the anagen phase to grow again and so the cycle continues.
However, when stress causes a disruption to this cycle, more hair moves into the telogen phase causing an increase in hair shedding and an overall thinning. This is one of the most common conditions that we see and can be either an acute telogen effluvium or a chronic telogen effluvium.
What are the different types of hair loss that can occur as a result of stress?
One of the most common types of hair loss is telogen effluvium, which is a widespread loss of hair on your scalp making the hair look much thinner. There is usually an excessive hair shedding, where you will see more hair in the sink / ‘plug hole’ when you wash it, as well as falling out when you brush.
This condition is basically a disruption to the normal growing and shedding hair cycle. It’s important to understand that stress can cause the growing phase of the hair to become shorter, with more hair moving into the resting and shedding phases which increases the amount of hair ‘fall’.
The good news is that telogen effluvium does not normally equate to permanent hair loss. Once we identify the underlying factors, we can treat it very effectively and the loss of hair density can be recovered.
This is where the autoimmune system attacks the hair ‘by mistake’, causing patches of loss to appear on the scalp. Normally, the patches are circular in shape and the size of a coin, although they can be larger too. This type of alopecia is not permanent, and the hair can recover and regrow. It is not fully understood what the triggers are for Alopecia Areata, however there is a clear association to stress, shock, bereavement, illness or accidents. Often there is an increase in underlying inflammation, which again can be caused by raised stress levels.
Frontal Fibrosing Alopecia:
This is a type of alopecia that attacks the pilosebaceous unit, (the growing unit of the hair), causing the hairline to recede and can cause recession and loss right back to the crown.
This condition is called a scarring condition as we cannot recover the hair once it is lost. Stress is again recognised as a trigger in this condition and there is always an increase in underlying inflammation.
This is known as a hair pulling disorder, where the sufferer has an irresistible urge to pull out their hair from the scalp and sometime other areas of the body too. It is a psychological and very complex condition. Stress is a major contributing factor in this type of hair loss as is anxiety, depression, and major traumatic life experiences. Trichotillomania leaves bald patches on the scalp which can become permanent, the treatment is complex and requires specialist management for successful treatment.
This is commonly known as male or female pattern hair thinning; it is a genetic condition and can be inherited from either parent. This condition is caused by a sensitivity in your hair follicles to both testosterone and a hormone converted from testosterone called dihydrotestosterone, (DHT).
If you have an inherited sensitivity, it can be triggered at various stages in life starting as early as puberty and as late as perimenopause. With this condition, the hair follicles miniaturise causing the hair to become thinner and finer until it is lost completely. Stress and anxiety can really intensify this type of hair loss and the reason for this is an increased production of cortisol, (often called the stress hormone). Cortisol can raise the level of testosterone in our bodies and can also increase the sensitivity of the follicles to the circulating testosterone.
Finally, let’s not forget issues around scalp heath such as seborrheic dermatitis and Psoriasis as stress can trigger and cause these conditions to flare up.
What treatments are there for people with stress-related hair loss?
There is hope. In many cases stress related hair loss can be treated effectively, but it would be too simplistic to say to a patient “just manage and reduce your stress”. A holistic approach is needed which involves and encompasses a collection of treatments. One of the first things I would recommend to any one is to eat well. A healthy balanced diet with a good portion of daily protein as well as keeping hydrated with water will help. Sleep is also very important - stress can affect our sleep patterns and good sleep is essential for healthy hair.
Everyone is different, so find out how to manage your stress, whether this is through exercise such as a brisk walk in nature or yoga, Pilates and Meditation work – all of which can work really well. I also believe that therapy can be another route to explore. Personally, I find doing something that I enjoy such as gardening, where I’m not thinking about anything other than the task in had works really well of me.