Excuse Me, Your Stress Is Showing

Everyone experiences stress, but if your hair is falling out in clumps, isn’t that really serious?

“Not really,” says Flor Mayoral, MD, FAAD, a cosmetic dermatologist and professor at Miami’s Miller School of Medicine. “Serious problems can show up in your hair, skin, and nails. But normally, stress reactions occur in students taking important exams, families moving to a new house, or someone starting a new job. Those are all pretty ‘normal’ stressors, not life-threatening situations.”

Asking questions leads to the best treatment. She recalls a patient who remarked, “I get bald spots every time I get divorced.” Mayoral politely asked how many times the patient had been married (three). Some people, she suggests, habitually do things that aren’t agreeable with their health but don’t always make the connection until a pattern develops.

“When someone suddenly develops acne, has a flare up of eczema, or rubs their fingers over their thumbnail frequently enough to cause a ridge, it’s important to ask why,” says Mayoral. “Much of the time, there isn’t a mysterious medical reason; they're just simply stressing out. They may not realize they're biting their fingernails because they are that preoccupied." Mayoral sometimes recommends that patients work with a psychologist who can help them modify their behaviors. “People can really benefit from talking to someone,” she says.

Some dermatological disturbances, Mayoral explains, have to do with cortisol, a stress hormone that can cause an increase in sebum oil, which results in acne. “I teach my patients to modify the use of their medications. For example, acne medication can be used more frequently than that which is usually recommended to counteract stressful episodes. I ask questions about how they are managing in other areas because exercise and diet are very important.”

The endorphin release that comes from exercise helps erase the negative effects of cortisol. And on occasion, Mayoral comes across a patient on a diet so restrictive that it doesn't provide enough nutrition to ensure healthy hair, nails, and skin.

Like a poor diet, “Not all problems are related to emotional stress,” says Mayoral. “Some are physical. For example, new mothers complain about hair loss when their babies are about 3 months old. Most likely, their hair was falling out all along, but they just haven’t noticed till now. It’s from the stress of carrying and delivering a baby.”

Empowering patients with a new strategy and positive thinking is key. “If my patients can make the link between the stress and the manifestation on their hair, skin, or nails, that’s really important. Then they can figure out how to manage their stress better,” says Mayoral. “Secondly, they stop obsessing. They’re not afraid to shampoo their hair because they know where the hair loss is coming from. They realize that this is just a transitory problem that will soon resolve. Getting to the root of the problem is really empowering because identifying the cause is enough to begin lowering stress levels before a patient leaves the office.”

— Michele Deppe