Stress and the Hair Growth Cycle: Cortisol-Induced Hair Growth Disruption

August 2016 | Volume 15 | Issue 8 | Original Article | 1001 | Copyright © August 2016

Erling Thom PhD

ETC Research and Development; Oslo, Norway

The specific proteoglycan replacement3 methodology further indicates a strong clinical rationale for supplementation against age-related hair growth disorders, as proteoglycan synthesis is generally reduced as a function of age. Moreover, the effect of topical 2% ketoconazole shampoo should be further researched for its ability to inhibit the effects of excess cortisol in a safe manner.
The treatment approaches described herein do not yet address the concomitant psychological implications that arise as a result of stress-induced hair growth disruption. Several physical stress-reducing activities have been shown to reduce cortisol levels, and quite recently, listening to music has been shown to significantly reduce chronic stress levels, as measured by the presence of cortisol through hair analysis.
It can therefore be concluded that addressing and treating the psychological aspects of stress-induced hair growth disorders justifies an equally interesting and important area for future research.


The author has received Honoria fees as consultant for Pharma Medico.


  1. Botchkarev VA: Stress and the Hair Follicle: Exploring the Connections. Am. J. Pathol. 2003;162:709-12.
  2. Tosti A, Piraccini BM, Sisti A, Duque-Estrada B: Hair loss in women. Minerva Ginecol. 2009;61:445-52.
  3. Krause K, Foitzik K: Biology of the Hair Follicle: The Basics. Semin. Cutan. Med. Surg. 2006;25:2-10.
  4. Batrinos ML: The endocrinology of baldness. HORMONES. 2014;13:197-212.
  5. Ito T: Hair follicle is a target of stress hormone and autoimmune reactions. J. Dermatol. Sci. 2010;60:67-73.
  6. Ito T: Recent Advances in the Pathogenesis of Autoimmune Hair Loss Disease Alopecia Areata. Clin. Dev. Immunol. 2013; Article ID 3498546.
  7. Hadshiew IM, Foitzik K, Arck PC, Paus R: Burden of Hair Loss: Stress and the Underestimated Psychosocial Impact of Telogen Effluvium and Androgenetic Alopecia. J. Invest. Dermatol. 2004;123:455-7.
  8. Arck PC, Handjiski B, Peters EM, Peter AS, Hagen E, Fischer A, et al.: Stress inhibits hair growth in mice by induction of premature catagen development and deleterious perifollicular inflammatory events via neuropeptide substance P-dependent pathways. Am. J. Pathol. 2003;62:803-14.
  9. Arck PC, Handjiski B, Hagen E, et al: Indications for a “brain-hair follicle axis (BHA)”: Inhibition of keratinocyte proliferation and upregulation of keratinocyte apoptosis in telogen hair follicles by stress and substance P. FASEB J. 2001;15:2536-8.
  10. Ito N, Ito T, Kromminga A, Bettermann A, Takigawa M, Kees F, Straub RH, Paus R: Human hair follicles display a functional equivalent of the hypothalamic-pituitary-adrenal (HPA) axis and synthesize cortisol. FASEB. 2005;19: 332-4.
  11. Foitzik K, Krause K, Nixon AJ, et al: Prolactin and its receptor are expressed in murine hair follicle epithelium, show hair cycle-dependent expression, and induce catagen. Am. J. Pathol. 2003;162:1611-21.
  12. Talbott S, Kraemer W: The Cortisol Connection: Why Stress MakesYou Fat and Ruins Your Health – And What You Can Do About It. 2nd ed. Hunter Press, Alameda CA USA 2007:126.
  13. Schmidt JB, Lindmaier A, Spona J: Hormonal parameters in androgenetic hair loss in the male. Dermatologica. 1991;182:214-7.
  14. Schmidt JB: Hormonal basis of male and female androgenic alopecia: clinical relevance. Skin Pharmacol. 1994;7:61-6.
  15. Gaillard Y, Vayssette F, Balland A, Pepin G: Gas chromatographic-tandem mass spectrometric determination of anabolic steroids and their esters in hair. Application in doping and meat quality control. J. Chromatogr. B Biomed. Sci. Appl. 1999;735:189-205.
  16. Wennig R: Potential problems with the interpretation of hair analysis results. Forensic Sci. Int. 2000;107:5-12.
  17. Gow R, Thomson S, Rieder M, Van Uum S, Koren G: An Assessment of Cortisol Analysis in Hair and its Clinical Applications. Forensiv Sci. Int. 2010;196:32-7.
  18. Ågren UM, Tammi M, Tammi R: Hydrocortisone regulation of hyaluronan metabolism in human skin organ culture. J. Cell Physiol. 1995164:240-8.
  19. Engelhardt D, Dörr G, Jaspers C, Knorr D: Ketoconazole blocks cortisol secretion in man by inhibition of adrenal 11 beta-hydroxylase. Klin. Wochenschr. 1985;63:607-12.
  20. Piérard-Franchimont C, De Doncker P, Cauwenbergh G, Piérard GE: Ketoconazole shampoo: effect of long-term use in androgenic alopecia. Dermatology. 1998;196:474-7.
  21. Inui S, Itami S: Reversal of androgenetic alopecia by topical ketoconzole: relevance of anti-androgenic activity. J. Dermatol. Sci. 2007;45:66-8.
  22. Westgate GE, Messenger AG, Watson LP, Gibson WT: Distribution of Proteoglycans During the Hair Growth Cycle in Human Skin. J. Invest. Dermatol. 1991: 96(2):191-5.
  23. Couchman JR: Hair Follicle Proteoglycans. J. Invest. Dermatol.1993;101:60S-64S.
  24. du Cros DL, LeBaron RG, Couchman JR: Association of Versican with Dermal Matrices and its Potential Role in Hair Follicle Development and Cycling. J. Invest. Dermatol. 1995;105:426-31.
  25. Kishimoto J, Ehama R, Wu L, Jiang S, Jiang N, Burgeson RE: Selective activation of the versican promoter by epithelial-mesenchymal interactions during hair follicle development. Proc. Natl. Acad. Sci. USA 1999;96:7336-41.
  26. Kishimoto J, Soma T, Burgeson R, Hibino T: Versican expression by dermal papilla-regenerated hair follicles – a promising tool for hair-regrowth products. Int. J. Cosm. Sci. 2004;26:165-6.
  27. Soma T, Tajima M, Kishimoto J: Hair cycle-specific expression of versican in human hair follicles. J. Dermatol. Sci. 2005;39:147-54.
  28. Malgouries S, Thibaut S , Bernard BA: Proteoglycan expression patterns in human hair follicle. Br. J. Dermatol. 2008;158:234-42.
  29. Zimmermann DR, Ruoslahti E: Multiple domains of the large fibroblast proteoglycan, versican. EMBO J. 1989;8:2975-81.
  30. Li Y, Liu Y, Xia W, Lei D, Voorhees JJ, Fisher GJ: Age-dependent alterations of decorin glycosaminoglycans in human skin. Sci. Rep. 2013;3:2422.
  31. Inui S, Itami S: A newly discovered linkage between proteoglycans and hair biology: decorin acts as an anagen inducer. Exp. Dermatol. 2014;23:547-8.
  32. Jing J, Wu XJ, Li YL Cai SQ, Zheng M, Lu ZF: Expression of decorin throughout the murine hair follicle cycle: hair cycle dependence and anagen phase prolongation. Exp. Dermatol. 2014;23:486-91.
  33. Trüeb RM: Pharmacologic interventions in aging hair. Clin. Interv. Aging. 2006;1:121-9.
  34. Arck P, Slominski A, Theoharides T, Peters E, Paus R: Neuroimmunology of Stress: Skin Takes Center Stage. J. Invest. Dermatol. 2006;126:1697-1704.
  35. Theoharides TC, Bielory L: Mast cells and mast cell mediators as targets of dietary supplements. Ann. Allergy Asthma Immunol. 2004;93:S24–34.
  36. Arck P, Handjiski B, Peters EM, Hagen E, Klapp BF, Paus R: Topical minoxidil counteracts stress-induced hair growth inhibition in mice. Exp. Dermatol. 2003;12:580-90.
  37. Linnemann A, Ditzen B, Strahler J, Doerr JM, Nater UM: Music listening as a means of stress reduction in daily life. Psychoneuroendocrinology. 2015;60:82-90.
  38. Sawitzke AD, Shi H, Finco HF, Dunlop DD: The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis. Arthritis Rheum. 2008;58:3183-91.
  39. Bruyere O, Reginster JY: Glucosamine and chondroitin sulfate as therapeutic agents for knee and hip osteoarthritis. Review article. Drugs aging. 2007;24:573-80.
  40. Wu Y, Wu J, Lee DY, Yee A, Cao L, Zhang Y, Kiani C, Yang BB: Versican protects cells from oxidative stress-induced apoptosis. Matrix Biol. 2005;24:3-13.
  41. Thom E. Nourkrin®: Objective and Subjective Effects and Tolerability in Persons with Hair Loss. J. Int. Med. Res. 2006;34:514-9.
  42. Thom E, Wadstein J, Thom EW, Kingsley DH: Treatment of Hair Thinning and Hair Ageing with Specific Lectican and Leucine Proteoglycans. A review. J. Appl. Cosmetol. 2014;32:105-15.