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The Daily Dish The Real Housewives of Orange County

Emily Simpson Has Stress-Induced Alopecia, and It's More Common Than You Think

A board-certified dermatologist explains everything you need to know about Telogen Effluvium, a common hair loss issue.

By Marni Eth

Emily Simpson and her husband, Shane, are approaching their 10th wedding anniversary, but home life has been less than idyllic. Shane is consumed by studying for the upcoming California Bar Exam, which means The Real Housewives of Orange County mom is left alone to care for their three kids. Shane’s absence from his home has taken a big toll on Emily, who recently noticed that her hair is falling out and is worried that she has a form of alopecia that can be caused by stress.

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The Lookbook spoke to Austin-based Board-Certified Dermatologist Sarah Gee, M.D. to explore the medical condition that can plague someone facing a great deal of stress. Dr. Gee explained that when “a medical indication for hair loss is not identified [like certain systemic diseases, medications, iron deficiency, or a thyroid abnormality], it is worth delving into patients’ responses to stressful events.”

Read on to learn everything you need to know about stress-induced hair loss, which is actually more common than you might think.

What is stress alopecia? 

Dr. Sarah Gee: The medical term for stress alopecia is "Telogen Effluvium" (TE), and this type of hair loss is characterized by excessive shedding of hair. Acute forms of stress alopecia usually occurs around three to five months after a stress, such as surgery, taking certain medications, weight loss/weight gain, or an upsetting life event. Stress can cause hair cycle changes that convert the growing hairs (anagen hairs) to shedding hairs (telogen hairs).

Another example is when new moms start shedding hair three to five months after childbirth. Chronic forms can last years, and typically affects women around the time of menopause and the frontal scalp. This kind can be more difficult to isolate and treat and could be caused by hormonal changes, metabolic abnormalities, and/or chronic illness.

How can you test for TE? 

The best way for a doctor to diagnose TE is by taking a good history and doing a physical exam. A biopsy can help to confirm the diagnosis, as well as a certain in-office test called a "hair pull test." It is considered normal to lose 50-150 hairs a day, and in TE, the numbers of hair shed per day exceeds 150 hairs.

Can TE happen to anyone who is extremely stressed?

Yes, in theory it could affect anyone after a stress — men or women. However, shedding following birth obviously occurs in women, as does certain iron deficiency conditions.

Does the hair ever grow back?

Yes, usually TE is a non-scarring form of hair loss, which means that once the hairs convert to their normal cycling (after the stress has resolved), the hairs will slowly grow back, though it can take several months.

What can be done to treat or prevent TE?

It’s not always possible to avoid most causes, unless there are major abnormalities in dietary habits that could contribute to iron deficiency, which is one of the most common causes. There is no specific treatment, but typically stopping medications that can cause it or correcting underlying nutritional or thyroid abnormality can help reverse it. Some reported therapies include watchful waiting, topical minoxidil medication, and platelet rich plasma injections (PRP).

Severe anxiety can cause weight loss, which in itself can cause stress-related alopecia. Therefore, tackling some stress triggers and finding healthy ways to cope with the sources of stress and anxiety can help to minimize some of the toxic effects.

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