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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.

Sebaceous glands

The sebaceous glands are glands that secrete sebum, an oily, acidic substance with a pH of 3.5. They are connected laterally to the hair follicle. Sebaceous glands are found with a density of approximately 100/cm2 throughout all areas of the skin. In the human body, they are located across the entire surface of the skin, except for the palms of the hands and the soles of the feet.

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Life cycle of hair

The life cycle of hair and its subsequent growth occur at a speed of 1-1.5 cm per month. Hair is a living element that follows a follicle cycle with an average duration of 2-6 years. In humans, unlike other mammals that are subject to a periodic change, this cyclic evolution is not synchronous (therefore each hair is independent from the others).

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Scalp itchiness

Scalp itchiness of varying intensity is a sensation perceived by many people of both sexes.
Itchiness is a scalp problem that leads those afflicted to scratch their skin and is often associated with pain. Many causes of this illness are recognized, which shouldn’t be underestimated as it may cause hair loss or thinning.

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Androgenetic alopecia (pattern hair loss) or baldness

Androgenetic alopecia is the most common type of hair loss and affects the majority of white men, with varying degrees of seriousness. It is less frequent in other ethnic groups. Often it can be associated with a family history of baldness, but the absence of other affected family members does not exclude the diagnosis. The condition is characterized by progressive hair loss in the crown area, the front hairline and the temporal area.

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Dandruff or pityriasis

Dandruff is a scalp condition that usually arises between the ages of 10 and 25. It may improve between the ages of 45 and 55 or may continue during old age.
Its cause is a result of an accelerated turnover of epidermal cells, which following an increase in migration speed, are unable to reach complete maturity before detaching. Whitish-yellow flakes (masses of corneum cells) form and detach, gathering in patches or often spreading evenly across the scalp.

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Structure and chemical composition of hair

The hair on our bodies has a particular structure and is divided into thin and thick hair. Thin hair, also called lanugo or vellus, is located on all skin surfaces except for the palms of the hands and the soles of the feet. Thick hair, also called terminal hair, is dark and located only in some areas such as the scalp, the armpits, the pubic area, the beard area in the case of men, etc…

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