Psychological effects of hair loss.

What is it hair loss?

Hair loss (alopecia) is a common problem that affects up to 50% men and women throughout their lives [1].

Hair loss can be broadly classified into scars (scar) alopecia and without scars (non-scarring) alopecia, with loss of scalp hair further classified as focal or diffuse alopecia.

Hair loss can occur anywhere on the body, but it most often affects the scalp. The abundant scalp has social and cultural importance. Loss of scalp hair, eyebrows and eyelashes frequently leads to psychological disorders.

What are the causes of hair loss?

The main causes of hair loss depend on whether the type of hair loss is scarring or non-scarring, and focal or diffuse.

Scarring alopecia is rare and is caused by injury, infectionand inflammatory skin disorders like discoid lupus erythematosus, lichen planopilaris, and folliculitis decalvana.

Focal non-scarring alopecia is usually caused by tinea capitis, a fungal infection of the skin, or alopecia areata (a autoimmune disorder).

Diffuse hair loss can follow hair loss, which is usually stress-induced hair loss (telogen effluvium) or is due to genetically determined male or female pattern hair loss [2]. Alopecia areata, medications, and various types of diffuse hair loss can also be caused by systemic diseases that include anemia, hyperandrogenism and thyroid disease.

Psychiatric riots, such as acute anxiety and endogenous depression, have also been considered possible causes of diffuse hair loss [3].

What else should I know about hair loss?

Whatever the cause, the more hair that is lost, the less likely it is to grow back.

• If the hair grows back, there may be repeated episodes of hair loss.
• The hair that grows back may be different in color and texture. [4].
• Medical treatment for hair loss is limited, especially for the most severe forms of alopecia.
• Surgical options, such as hair transplants, can be used for specific types of hair loss, but they have their own limitations.

What are the psychological effects of hair loss?

Research on the psychological problems associated with hair loss is limited.

Evidence confirms that the experience of hair loss is psychologically damaging, causes intense emotional distress, and often leads to personal, social, and employment problems. People with severe hair loss are more likely to experience psychological distress than those with mild hair loss. [4]. Hair loss changes a person's appearance, particularly when the eyelashes and eyebrows are affected, as they define a person's face. Hair loss can be seen as a breach of physical appearance norms within society. [4].

The relationship between hair loss and psychosocial The consequences can be complicated by hair loss occurring from a stressful experience or life event, which then leads to further distress, anxiety and depression. [5]. Women who experience high levels of stress are 11 times more likely to experience hair loss than those who do not report high levels of stress. [6].

Compared to the general population, people with hair loss have an increased predominance of psychiatric disorders, including a major depressive episode, an anxiety disorder, social phobia, or a paranoid disorder [7].

What are the clinical features of anxiety/depression due to hair loss?

Hair loss can lead to depression, anxiety, and social phobia.

• Depression can lead to a feeling of low mood, lack of interest or pleasure in activities, loss of energy, and lack of sleep.
• Anxiety can cause excessive worry, difficulty controlling those feelings, and a feeling of heightened tension. Patients may also complain of palpitations and sweating.
• Social phobia or avoidance behavior stems from the experience of anxiety symptoms, leading to social and economic suffering.
• Social anxiety disorder is characterized by fear of humiliation or being judged negatively in social situations, as well as avoiding such social or performance situations. [8].

These symptoms can have a severe impact on an individual's mental health, ability to work or study, and well-being.

What is the treatment for anxiety/depression due to hair loss?

Anxiety and depression caused by hair loss can be treated with cognitive behavioral therapy and support groups, as well as medications such as antidepressants. [9].

Psychological treatment is important for people with hair loss, but the best method is not safe and will differ from patient to patient. Research has primarily focused on the general problems of coping with hair loss rather than specific psychological treatment strategies.

What additional research is required on the psychological effects of hair loss?

A strong theoretical understanding of the psychological impact of alopecia is required, including knowledge of the immune system, stress response, and psychological responses to hair loss. Appropriate treatment strategies and regimens should be established, implemented, and studied in a clinical setting.

Self-consciousness about body image is constantly portrayed and commented on in the media. The role of the media in emphasizing the expectation of a full head of hair should be explored, as well as how it can be used to educate society about hair loss and tolerance of people's physical differences.