FEATURE physical, psychological, or environmental, the body upregu-lates CRF production. Interestingly, skin has been found to contain CRF, other HPA axis hormone analogues, and their receptors, indicating that there is neuroendocrine activity at the dermal layer (Arck et al, 2006). The presence of CRF has been found to simultaneously inhibit the elongation of the hair shaft and induce the premature regression of the hair follicle (Arck et al, 2006). This is achieved by arresting the cell cycle at the G2/M phase and increasing the accumulation of reactive oxygen species (ROS) (Lee et al, 2020). High levels of CRF also inhibits the proliferation of DPC, increases the production of reactive oxygen species, decreases growth-related molecules and increases regression-related molecules (Lee et al, 2020). Additionally, the increase of substance P, a stress-related neuropeptide, is associated with premature hair loss (Peters et al, 20006). Substance P increases mast cell degranulation, increases number of entering the late stages of catagen, and inhibits hair shaft elongation (Peters et al, 2007). Type of Stressor Metabolic Examples • Acute febrile illness • Severe infection • Post-partum hormonal change • Decrease in estrogen • Discontinuing estrogen-containing medication • Hypothyroidism • Severe trauma • Major surgery • Crash diet • Low protein intake • Heavy metal ingestion • Iron deficiency • Beta B-Blockers • Excess vitamin A • Anticoagulants • Propylthiouracil • Carbamazepine • Immunizations Hormonal Lifestyle/Environmental Medications Diagnosis and differential A thorough history and physical exam is typically enough to Table 1. Examples of Common Stressors make a diagnosis of TE (Hughes & Saleh, 2021). The most common scenario is presented is an abrupt onset of hair placebo-controlled study, it was found that supplementing shedding with little to no other symptoms. One must be with 300 mg of Ashwagandha twice daily for 60 days signifi-diligent to question potential causative events 3-6 months cantly reduced scores on the Perceived Stress Scale, improved prior to the onset of hair shedding(Hughes & Saleh, 2021). scores on the General Health Questionnaire-29, and Depres-The clinician can opt to perform a pull test, which may or sion Anxiety Stress Scale, and reduced cortisol levels (Chan-may not yield positive results. A positive test is at least 4 hairs drasekhar et al, 2012). Another adaptogenic herb that may play a role in hair growth is ginseng (Choi et al, 2018). removed with each pull (Hughes & Saleh, 2021). If there is concern of other co-morbidities (e.g. hyperthy-Ginseng has the potential to promote hair growth and prevent roidism or iron deficiency) either causing or aggravating the hair loss by encouraging the anagen stage while inhibiting the hair loss, further testing may be indicated (Hughes & Saleh, catagen stage (Truong et al, 2017). 2021). The differential diagnoses list can include: Alopecia An emerging treatment for hair loss, TE and otherwise, is Areata; Anagen Effluvium; Androgenetic Alopecia, Scarring low level laser therapy (LLLT) (Avci, et al, 2014). Low-level Alopecia, Syphilis; and Trichotillomania (Hughes & Saleh, laser therapy stimulates cellular activity, while near-infrared 2021). laser light promotes regeneration (Avci et al, 2014). Com-monly used devices have wavelengths in the 500-1100 nm range, with most evidence pointing towards 655 nm as target Prognosis and treatment TE is a self-limiting condition that typically lasts about 6 wavelength (Amer et al, 2021). LLLT has been found to be months (Peters et al, 2006). When deciding how to proceed safe and effective in both animal studies (Avci, et al, 2014) with treatment strategies, it is key to review the patient’s and human studies, in both males and females (Yoon et al, history and to determine whether the initial stressor was 2020). metabolic, hormonal, lifestyle/environmental, or due to med-ication. If the initial stressor has either been removed or SUMMARY treated, there is little need to use additional therapies (Hughes Telogen effluvium is a short-term, self-limiting condition in & Saleh, 2021). Conventional hair growth treatments are which there is diffuse hair loss after a stressful event. The typically not used in cases of TE, however, the patient can interplay between various stress hormones has been directly implicated in the condition, as they both inhibit the growth choose to apply topical minoxidil (Hughes & Saleh, 2015). When treating a TE patient using the Naturopathic ap-of hair and speed up the transition from growth to rest phase. proach, the emphasis shifts towards supporting the adrenal Since TE is self-limiting, treatment is not necessary. If the glands and regulating the HPA axis. Additionally, it is imper-patient, however, desires a more hands-on approach, there ative to review key foundational aspects of the patient’s life-are various conventional and naturopathic treatment options style such as stress management/restoration techniques, re-that can target hair growth and support and restore the body’s ducing inflammation, improving diet and correcting ability to handle stress. nutritional imbalances, and improving the quality of sleep. A class of herbs that is particularly useful in the treatment of TE are adaptogenic herbs. One of the best studied adap-To view the list of references, visit cndoctor.ca/stress-hairloss togenic herbs is Ashwagandha, or Withania somnifera (Chan-drasekhar et al, 2012). In a randomized, double-blind, 16 Chiropractic and Naturopathic Doctor January/February 2022 www.Cndoctor.ca
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