Stress Can Take Your Hair Away

Traumatic events can trigger massive, prolonged shedding

SUNDAY, March 17, 2002 (HealthDayNews) -- You get up one morning, and your pillow is covered with hair. Not just a few strands, but dozens. So is the drain after you take a shower, and the towel after you dry off.

It could be many things, which is why you should see a doctor. However, experts say it could also come from a highly stressful event in your life, such as losing a loved one or a job, having a baby, or being in a serious accident.

"Medically, patients under stress undergo a lot of changes and unbalance their bodies," says Dr. Wilma Bergfeld, director of clinical research in the Department of Dermatology at the Cleveland Clinic. "Growing hair follicles are the most sensitive group of cells in your body. Anything that adversely affects your body affects your hair."

The medical term is telogen effluvium, and it refers to one of the normal phases of hair growth. The anagen phase is when hair is growing; the telogen phase is when it dies, becomes loose in the follicle and falls out.

In the regular pattern of hair growth, another new hair would be right behind it. People usually lose about 100 strands a day of the 100,000 or so on the average scalp. Normally, about 10 percent of hair is dying at any time. When telogen effluvium occurs, the balance shifts, and about 30 percent of hair moves into the telogen phase.

Any number of physical or emotional situations can cause it, Bergfeld says. Young children lose hair after high fevers or prolonged infections. In children older than 10 and in adults, it can be a sign of a metabolic or genetic condition.

"Shedding is abnormal -- it defines something medical has happened to you," she says.

It can be a sign of early baldness in males and females, which is genetic. Nutritional deficiencies, thyroid imbalances or polycystic ovary syndrome can cause it. In addition, medications such as lipid-lowering drugs, birth control pills or hormone replacement therapy and unregulated herbal treatments can trigger it.

Once any underlying physical or pharmacological causes are ruled out, look at the calendar and see what was happening in your life a few months ago.

"We're not talking about everyday stress," Bergfeld says. "This is the stress that sort of wipes you out."

Dr. Oscar Klein, an internist and psychiatrist in New York City, says stress-related hair loss is similar to what happens with chemotherapy.

"That's a chemical, but it's the same process," he says. "It's a shock to the process. A psychological shock isn't just in the mind -- it's a mind-body duality."

The good news is that unless someone has a genetic predisposition to disease or baldness, telogenic effluvium should correct itself within six months to a year.

"You must reassure them their hair won't keep falling out," says Klein, who is medical director of Physicians Hair Growth. "They may lose half their hair; it can be very scary."

The shedding can be reduced with topical minoxidil and shampoos with nizoral and ketoconazole, Bergfeld says. She also recommends sufferers eat a balanced diet, take a vitamin with iron and some extra zinc, and be nice to their scalps.

"I always say you should treat your scalp like a cashmere sweater," she says. "You don't burn it, and don't use heavy chemicals on it."

Most of all, find a doctor who is interested in treating the condition. Dermatologists receive the most training in the diagnosis and treatment of telogen effluvium, Bergfeld says. Even then, she urges patients to keep looking if a doctor says there's nothing that can be done.

"Some doctors don't think hair loss is an important-enough disease for them to take care of," she says. "It is a devastating disease for people who have it. Like acne, self-esteem goes down the toilet. Sociability goes down the toilet. Their ability to get a job goes down the toilet. It can cause serious depression. In some aspects, it's as important as a major medical problem."

What To Do: For more information on telogen effluvium and photos of what it looks like, visit the Canadian Hair Research Foundation. There's an article on its treatment in the American Medical Association's Archives of Dermatology.

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