If you have alopecia areata (AA), your doctor may have spoken to you about the amount of stress in your life, and advised you to reduce it. But does the science support the assumption that stress is a contributing factor or trigger?
Kevin J. McElwee, PhD, assistant professor at the University of British Columbia, Department of Dermatology and Skin Science, conducts dermatology and hair biology research. His focus is almost exclusively on hair including AA, hair follicle cycling and disease development, and the many diverse roles of the hair follicle in cutaneous disease and tissue regeneration.
Dr. McElwee’s published work is primarily for the scientific community, however some of what he writes is also enlightening for non-scientists. For example, in the May/June 2011 issue of Dermatologic Therapy, he writes that the affect of “alopecia areata can be recurring, abrupt, unpredictable and emotionally disturbing,” and he talks about the role of stress in AA.
It’s fair to assume that most people diagnosed with AA have at some time been told that the condition is due to stress and have been advised to ramp down the stress in their lives. But then how do you explain AA onset occurring at times of great happiness and very little life stress?
Others say the relationship is the other way around — that having the condition causes stress, or makes it worse.
So what should a woman with AA believe about the relationship between stress and alopecia? Is it even “off the hook” given some recent genetic research?
Wang and McElwee* shed some light on the subject**:
“The onset and progression of AA probably requires input from multiple factors including genetics, stress, hormones, diet, infectious agents, vaccinations, and several other possible inputs. Potentially, these factors may increase or reduce susceptibility to AA onset, influence the disease pattern, severity, duration, and response to treatment by modifying the physical and biochemical status of the immune system and/or hair follicles. Different factors may be prevalent for different individuals with AA … (S)pecific genes are likely to play very important roles in AA. However, the influence may vary from person to person. For some, genetics may play the dominant role with little environmental input. For others, environmental influence may be more dominant while genetics makes a relatively minor contribution. Thus, when dermatologists and scientists argue in support of ‘stress’ being a trigger versus ‘infectious agents’ versus ‘genetic susceptibility,’ each of these factors may be important for different subsets of patients. Many hypotheses have been raised as to what may trigger and modulate AA but the specific environmental risk factors and their relative contributions are still largely to be determined.
One of the most commonly cited causes of AA is psychological stress. However, in controlled clinical studies, no correlations between reported stress levels and AA have been observed. Studies on specific stressful events experienced by AA patients have revealed contradicting results on whether it is causal or unrelated to the development of AA. As such, the clinical data in support of the claim that stress can trigger AA onset is not strong.”
Therefore, the answer according to these authors is that clinical research at this time has not produced enough data to determine the role of stress in causing alopecia.
*Eddy Wang, Department of Dermatology and Skin Science, University of British Columbia; Kevin J McElwee, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
**To see the reference citations and complete article
Wang E, McElwee K. Etiopathogenisis of alopecia areata: Why do our patients get it? Dermatologic Therapy 2011: 24: 337-347.
