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The bald facts: Why your hair has begun to fall out and what you can do about it

Stress can be a common feature in those with alopecia. Liz Connor talks to a dermatologist to find out more

Difficult times: thinning hair can become a big concern
Difficult times: thinning hair can become a big concern

By Liz Connor

Shedding hair is normal - experts say we can lose up to 100 strands per day. But if you've noticed excessive amounts of hair in your plughole, and that your hair is noticeably thinning or bald patches have appeared, it could be a sign of that something's not right.

Hair loss can be very distressing to deal with, especially feeling like you have no control over what's happening, so it's only natural that losing it may be a frightening thought.

But the first rule of hair loss is not to panic. There are lots of things that can trigger us to shed more than usual - like a nutritional deficiency, dramatic weight loss or even just old age.

Hormonal changes or imbalances may also be a factor. In some cases, increased hair loss may be a specific form of alopecia, such as alopecia areata which causes patchy baldness.

Stress-related hair loss is also not uncommon - and with rates of chronic stress and burnout on the rise, if you've noticed your stress levels taking a toll physically, you're not alone.

If you're concerned about hair loss, it's a good idea to see your GP. They'll be able to advise on possible causes and how to manage the situation.

We asked Sharon Wong, consultant dermatologist at HCA at The Shard, part of London Bridge Hospital (hcahealthcare.co.uk), to explain more.

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Can stress cause hair loss?

In a nutshell: yes. It's something we're used to seeing portrayed in TV and film, but it's no myth that stress can literally make your hair fall out. This is known as alopecia; a general term for hair loss. However, it's important to remember: not everyone experiences stress-related hair loss - but this does not mean some people are 'better' at handling stress than others, or that people with hair loss have somehow caused it themselves.

In fact, there's a lot of mystery around alopecia, but some experts believe genetics and abnormal immune system responses may play a key part.

"It isn't fully clear how stress affects hair, but what we do know is that the skin and mind are connected and communicate with each other in some way," explains Wong.

"Based on this knowledge, many experts believe that stress may result in neurochemicals being released from the brain, that can modify the way our skin's immune system behaves, predisposing us to skin and hair conditions."

There are three main ways that stress can affect your locks:

1. Telogen effluvium

Acute stress - caused by accidents, break-ups and surgery, for example - can sometimes lead to acute telogen effluvium, or reflective hair shedding.

"Telogen effluvium, known as TE, is a form of temporary hair loss which typically causes dramatic shedding of hair from all over the scalp and loss of total volume of hair," says Wong.

She explains that, at any given time, about 85-90% of the hair on a person's head is actively growing. This is what's known as the anagen phase.

"Typically, the anagen phase lasts between two to seven years before it enters a short transition phase when the hair follicle stops growing. This is followed by a resting phase which lasts for two to four months, after which the old hair is expelled and then replaced by a new hair."

In a person with TE, trigger factors - such as stress - can push more hairs into the telogen phase prematurely, resulting in increased shedding. Reassuringly, Wong says TE doesn't cause complete baldness, although the hair becomes more noticeably thin.

2. Alopecia areata

Alopecia areata is a condition that causes specific spots or patches of baldness to appear in random areas on your scalp.

These are usually circular with defined, noticeable edges and can vary in size; they're typically around the size of a coin but can be bigger.

It's largely believed to be an autoimmune disorder, which causes your body to confuse certain hair cells as foreign enemies and attack them.

"There can be several triggers for alopecia areata, and factors that can make some people more at risk than others - such as having a personal or family history of other autoimmune conditions, like thyroid disease or vitiligo," says Wong. "However, some patients can link the onset of their alopecia areata to a stressful life event."

3. Trichotillomania

Ever had the urge to pull out your hair when you're highly stressed? There's a name for compulsive hair-pulling: trichotillomania.

It can often be a response to dealing with negative or uncomfortable feelings, such as stress, anxiety or tension.

Also known as 'trich', the urge to pull hair might also extend to other places, such as eyebrows or eyelashes. The NHS say it's more common in teenagers and young adults and tends to affect girls more often than boys.

The condition can be very distressing and sometimes cause extensive hair loss. However, there are therapies and strategies that can help and lots of people are able to manage the problem successfully.

Will the hair grow back?

The good news is, stress-related hair loss doesn't usually happen overnight and there are often ways you can reverse it.

For some people with alopecia, hair loss may be an ongoing cycle of shedding and regrowth and in some cases can be severe - although this is rare.

"It is important for people to avoid self-diagnosing their alopecia," says Wong, "and to see a specialist who can provide an accurate diagnosis and management plan.

"In stress-related TE, the hair will recover on its own, provided the initial trigger resolves.

"The hair cycle tends to normalise and the hair will gradually start to grow back. There is, however, a lag phase before recovery is noticeable.

"When alopecia areata appears in adulthood in small localised areas, the outlook is good too," she adds. "Up to 80% of patients can spontaneously regrow hair even without treatment, usually within the year.

"However, the condition can be unpredictable and may get worse before it gets better."

If stress is a trigger, Wong advises booking an appointment with your GP or a dermatologist - they will be able to recommend good counselling support too.

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