Scientific Area

Psychogenic alopecia (psychological baldness)

CATEGORIES SCIENTIFIC AREA

Scientific collaboration between Professor Marco Toscani and Dr. Pasquale Fino, Chair of Plastic, Reconstructive and Aesthetic Surgery, Umberto I Health Center – “Sapienza” University of Rome.

Psychogenic alopecia is a type of hair loss related to stress. Though not yet scientifically explained, this connection is well-known in the experience of those working with the problem. In addition to stress, other causes are personality disorders, states of anxiety and depression, all of which are conditions of acute or chronic stress.

Quando lo stress è la causa dell’alopecia

The mechanism of action is nevertheless related to a “somatization” process or rather to a physical reflection of psychological stress; this makes the condition different than traction alopecia (hair loss from pulling), which is also related to a psychological disorder but of the behavioural type (it is a mechanical action that leads to the condition of hair loss).

Before defining the hair loss as psychogenic, spot baldness and pattern hair loss need to be excluded. This is not a simple diagnosis and the conditions may even overlap. More than one study has implicated the hypothalamus and the pituitary gland in the biological reaction to stress, which leads to the release of adrenocorticotropic hormones in the circulation that affect cells involved in hair formation and nourishment: cells producing sebum, keratinocytes, fibroblasts and immune cells. This reaction leads to: hypersecretion of sebum that often turns into seborrheic dermatitis; trichodynia (sensation of scalp pain), especially around the crown; perifollicular inflammation (reddened skin around the hair region).

All of these symptoms may also occur in the other two types of hair loss mentioned above.
Unlike spot baldness, which generally proceeds in patches, female stress-related hair loss leads to a scattered thinning of hair, more marked in the crown area, without recession of the hairline. In men, in addition to general thinning, the condition also leads to a receding hairline.

Le cure dell’alopecia da stress (o alopecia psicogena)

Obviously the best cure is removal of the stress, but this is particularly difficult, especially in individuals suffering from psychogenic hair loss who are definitely people that tend to have difficulty releasing their tension. It may prove hard to remove the cause for the stress and even psychotherapeutic approaches may take a lot of time without ever guaranteeing complete removal of the stress.

Treatment definitely requires consistency and perseverance. The therapy includes: minoxidil, finasteride and laser therapy, which do not remove the cause but are a valuable aid in countering the effects of the stress.

Hair loss: manifestation, causes and prevention

A shedding of hair is considered physiologically normal when hair loss is limited to around one hundred hairs per day. During an individual’s life hair grows, falls out and regrows around twenty times. Each cycle, especially for females, may last up to six years and if hair loss is found within this time frame, it is considered absolutely physiological.

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Premature hair loss

Recent studies have demonstrated that around one in five young men tend to lose their hair prematurely over time.
This problem does not affect only young men but also young women.

In the majority of cases, it is androgenetic alopecia (pattern hair loss) and therefore is hereditary/genetic. However, it is important to remember that often factors of psychological origin like performance anxiety, trauma and emotional stress take over, thereby becoming a source and cause of hair loss from stress.

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Scalp psoriasis

La psoriasi è una frequente dermatosi cronica eritemo-squamosa con squama tipica (psoriasica), circoscritta o diffusa.
La psoriasi è un problema del cuoio capelluto non annoverata tra le cause che comportano la caduta dei capelli.

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Hyperhidrosis

Excess sweat production on the entire surface of the body or just in some areas (especially the scalp, palms of the hands, soles of the feet) is called hyperhidrosis.
Some of the causes that may lead to temporary hyperhidrosis are physical hyperactivity, fevers, saunas, vomiting and dysentery. Causes that may instead lead to a repeated state of hyperhidrosis are hyperthyroidism, hypoglycemia and alcoholism

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Scalp pain

Scalp pain and irritation (or trichodynia) are pathological conditions that affect both women (in a greater percentage) and men (in a lower percentage). The pain felt on the scalp, spontaneous or caused by treatment, and in particular around the roots of the hair, may be more or less intense, alternating at times between periods of disappearance, associated with burning, tingling or itching.

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Cuneiform hair or dwarf hair

This is very short hair, between 1 cm and a maximum of 2 cm in length, which usually has insufficient pigmentation. This hair has a base structure that is quite large, almost like normal hair. It then tends to get smaller towards the end, thus taking on the form of a very pointed cone.
This hair has a strong tendency to fall out.

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