The role of psychological stress in hair loss: A review

Psychological stress has long been implicated in the pathogenesis and exacerbation of a multitude of hair loss disorders including telogen effluvium, androgenetic alopecia, and alopecia areata. This review synthesizes the current evidence on the immunologic, neuroendocrine, and oxidative mechanisms linking psychological stress to hair follicle dysfunction, highlighting the role of the hypothalamic-pituitary-adrenal axis, neuropeptides including substance P, and proinflammatory cytokines. We explore validated tools for measuring stress, the psychosocial burden of stress-related hair loss, and lifestyle contributors involved in stress-related hair loss. Additionally, we discuss emerging therapeutic approaches targeting stress-related pathways. In some hair loss disorders, there is evidence suggesting a bidirectional relationship between stress and hair loss. We propose an integrative approach to hair loss management that involves psychosocial assessment, behavioral interventions, and novel pharmacologic strategies. Future research is needed to further understand causal pathways and evaluate long-term efficacy and safety of treatments.