Stress and Hair Loss

Understanding Hair Loss Conditions

The British Association of Dermatologists guidelines list early scarring alopecia in the differential diagnosis of alopecia areata, emphasizing they are separate entities 1, 4
Telogen effluvium is a stress-induced shedding where up to 80% of patients with limited duration (<1 year) experience spontaneous remission 1, 2
Dermoscopy aids differentiation between alopecia areata and cicatricial alopecia, with yellow dots, exclamation mark hairs, and cadaverized hairs suggesting alopecia areata (non-scarring), while their absence with follicular ostia disappearance suggests cicatricial alopecia 4
Psychological stress impacts quality of life in any hair loss condition, but this does not mean stress caused the scarring 5, 6

When diagnosis is uncertain, perform skin biopsy to distinguish cicatricial from non-scarring alopecia 1, 4

For stress-related non-scarring alopecia, reassurance is appropriate for telogen effluvium with spontaneous remission expected, and addressing psychological factors including depression and anxiety that may accompany or exacerbate the condition is necessary 1, 2, 5