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Plus, how you can reverse the effects.
By Aly Walansky — Written on Aug 08, 2020
You might be joking with friends about how this lockdown and added stress is making your hair fall out. Turns out, hair loss from COVID-19 is real. And that's true for those who have gotten sick, and even people who aren't.
Experts on hair loss and hair restoration have begun to notice a disturbing pattern in the last few months since the start of the COVID-19 epidemic.
When did this trend of hair loss begin?
Experts at Philp Kingsley have started to see clients in the clinic with the results of hair loss due to COVID-19.
“It’s due to high temperature, post febrile alopecia. Recovery could be longer than in usual cases as the patient may remain sick for a long period of time. People suffering should look for stimulating products. At the Philip Kingsley Clinic, we are prescribing our clinic scalp cream and tonic for stimulants,” says Lisa Caddy, Consultant Trichologist at Philip Kingsley Trichological Clinic.
She’s not alone in noticing this disturbing trend.
Adds dermatologist Dr. Daniel Belkin, “I have seen a couple of people with hair loss who told me that they were diagnosed with COVID and hospitalized, usually 3-5 months prior to their visit with me. I'm not sure I would call these cases more extreme than usual, but the hair loss is still relatively sudden and frightening for patients.”
These concerns are echoed in Survivor Corps, a Facebook group made up of people who have COVID-19 or have had it. The topic of hair loss has begun to creep into conversations. Says one member, “I got real sick with COVID in April. Thank God I recovered, but now I’m worried about the lasting after effects. My hair has been falling out way too much and I’m too scared to brush it.”
These patients had noticed a sudden onset of increased hair fall (more shedding when combing their hair or in the shower), and sometimes decreased density of hair throughout the scalp. Some can see their scalp through their hair when they weren't able to just a few months prior.
What is causing hair loss in those exposed to coronavirus?
It's definitely possible that this kind of hair loss (which the experts term as telogen effluvium) is related to psychological stress as well as to physical stress.
“Either type of stress can cause more hairs than usual to simultaneously shift from a growth phase into a resting phase,” Dr. Belkin adds.
The resting phase lasts about 3 months and culminates in shedding of the hair shaft, so it's only months after the stress that this shift is noticed.
Belkin reveals, “I have seen people recently with this sudden type of hair loss who also have not been diagnosed with COVID or hospitalized, and I chalk it up to the early quarantine psychological stress of March.”
While a lot of people may see these effects after suffering from COVID-19, it’s also possible they are suffering hair loss due to the stress and life-altering aspects of the pandemic itself — even if they never caught the virus!
“I have not noticed a difference between COVID-associated telogen effluvium and typical telogen effluvium,” Dr. Belkin says. “It seems to me that the timing is typical for telogen effluvium, which is about 3-5 months after a precipitating event.”
Coronavirus can cause many of the factors that individually might precipitate hair loss, including psychological stressors like prolonged fear, death of a family member, or loss of a job; and physical stressors like severe illness, infection, high fevers, hospitalization, weight loss, and/or new medications.
Questions about hair loss and COVID-19 are also impacting what people are researching on the Internet. “At Zenagen, we have definitely noticed more inquiries about hair loss on our website in the past several months,” says Jared Reynolds, founder of Zenagen.com. “There’s been a 30 percent increase in clicks about hair loss and a 120 percent increase in searches specifically for hair less after illness."
Reynolds says these searches coincide with what researchers know about sickness, stress and hair loss.
“It makes sense that people are experiencing hair loss, known as telogen effluvium, after COVID-19 for several reasons,” explains Reynolds. “Usually, we shed around 100 hairs a days. But when you’re sick, the body becomes more sensitive to inflammation, which accelerates hair loss — sometimes several hundred hairs per day.
The problem is that the hair loss itself often leads to more stress, which leads to more loss. In addition, hair loss can be a common side effect of drugs that are used to treat COVID-19, like steroids and remdesivir. The good news is that we expect this hair loss to be temporary and will resolve in six-to-nine months.”
Even if we don’t test positive for COVID-19, we are all under much more stress than normal from fear of the disease, lifestyle disruptions and the unknown going forward.
Adds Reynolds, "The disruption in the routine of our daily lives and the unknown about what’s ahead can also lead to hair loss and shedding. Plus, because we’re staying inside more, the reduction in vitamin D that we normally absorb during summer can also lead to hair loss.”
COVID-19 or not, once you’re experiencing active shedding, all of the normal hair care recommendations apply.
Hair shedding is actually often seen with many types of virus and infection aftermaths. “If you have a viral or other infection, and especially with associated fever, hair shedding is one of the known common sequelae,” Hair Restoration Surgeon Dr. Alan J. Bauman brings up.
We all know genetics and other underlying medical problems impact the way our bodies fight infection and handle other stressors. For many, habits and routines have changed, which can have physical and psychological effects.
Adds Dr. Bauman, “In that same vein, you don’t need to be physically infected with COVID to be feeling the detrimental effects of the pandemic on your hair and other organ systems.”
In what other ways has the coronavirus pandemic affected our hair, and why?
1. Fever
Many of those infected with COVID never exhibit symptoms. However, otherwise asymptomatic COVID patients may have a fever.
“We know people experiencing high fever often enter a synchronized shedding phase, or telogen effluvium, approximately 6 weeks after the start of the fever,” reveals Bauman. This shedding may last several weeks before normalizing.
2. Stress and anxiety
Stress has a wide-ranging effect on many organ systems, including the digestive tract, brain, and hair follicles. “Abnormal cortisol levels can also affect hair follicle function,” Bauman adds.
Although stress is often a major cause of hair loss, there is also an underlying condition present which is triggered by stress. So, stress is not the root cause, but it can act as a trigger.
"More and more people are reporting hair loss during COVID because it's a stressful time and, for those whose bodies take on stress in a more chronic response (i.e., they don't release the stress hormone, cortisol, after the immediate threat has passed), hair loss can occur," reveals Emma Sothern of Lady Alopecia.
3. Nutritional disruption
Loss of appetite, nausea, vomiting, and diarrhea are well-known symptoms of COVID. All these things can also mess with our hair.
“Your body expends a great deal of energy making hair, so disruptions in nutrition due to quality or quantity of intake, as well as anything affecting malabsorption, including disruption of the gut microbiome, can have a detrimental effect on the highly metabolic population of hair follicles on the scalp,” explains Bauman.
“For perspective, a single gram of hair, which is about the quantity of hair you could fit into a standard sugar packet, requires nearly 650kJ of energy to produce, which is about the energy required for about 15 minutes of vigorous cardio exercise.”
4. Sleep disruption
Stress from income loss, job insecurity and isolation may be impacting your sleep. All this is bad for hair as well.
“New research suggests that the complex local control of chronobiology of the hair follicle cycling may also be influenced by the brain’s natural circadian rhythm,” reveals Bauman.
This may explain why night-shift workers, severely jetlagged travelers, and those with significant sleep disruptions (trouble falling asleep, staying asleep, or impaired sleep phases) can experience chronic shedding and other hair loss symptoms.
5. Changes in blood flow
COVID-19 has been linked to blood clotting and blood flow issues. Blood flowing to the scalp is important for scalp and hair health as well.
“Due to the restrictions in blood flow and clotting issues related to COVID-19, there very well could be a mechanism of reduced blood flow to the hair follicles, and it will starve out existing robust hairs, causing a massive shed in anagen effluvium type scenario,” William Gaunitz, WTS, certified trichologist, says.
If the clotting is reduced, blood flow may return to relatively normal and hair may grow back. But an additional reason may be starvation of the hair follicles by reduction in nutrition in the blood supply to the hair.
“Due to the clotting factors and other respiratory problems, the demand and availability to certain key nutrients like serum iron and ferritin may be drastically altered while the virus is in full activity.
Because of this, it's also possible that a reduction in supply of iron or ferritin to the hair during the active virus may result in drastic shedding and hair loss. Assuming the individual is able to return to normal soon thereafter, there may be a full recovery made,” Dr. Gaunitz adds.
6. Compliance
As everyone has been staying at home more, a lot of our normal routine has fallen to the wayside. People are missing routine check-ups and doctor's appointments, and may be falling behind on their treatments and regimes.
Priorities for many have changed as quickly as lockdown orders, work from home, and learn from home realities came about. These disruptions have resulted in many hair loss patients neglecting their hair retention strategies.
Can you reverse the effects of hair loss?
The good news is, this disturbing hair loss can leave as easily as it arrived. Experts say this type of hair loss should resolve on its own within six months, as the normal hair cycle resumes.
Dr. Belkin weighs in: “Human hair shafts each have individual clocks that determine growth phase, resting phase, and shedding, such that at any given time there is a relatively stable number of hairs. If shedding remains high or density remains low past six months, we may do further work-up to find out what the persistent stimulus is.”
Though a traumatic event shifts hairs toward telogen (or resting phase) simultaneously, eventually, they will resume their independent cycles.
Here's what to do to help your hair grow back and recover from hair loss.
1. Treat your hair and scalp very gently.
Avoid harsh products and scalp scrubs.
If your hair and scalp is in a sensitive place, you don't want to be aggressive with scrubs and treatment and tools. Just like if your skin was having a rough patch, this wouldn't be the time to try aggressive peels.
2. Use low heat settings on your hair styling tools.
Use your blow dryer or thermal styling tools on the lowest heat settings. Or, if possible, stop using your styling or heating tools altogether.
Extreme heat can damage hair, and the healthier hair is, the better shape it will be to start its recovery.
3. Leave your hair down.
Don’t wear tight ponytails or braids that can put extra stress on your hair and scalp. Tight ponytails or too much tension on the scalp actually encourage more hair breakage, rather than less.
4. Eat healthy food.
Foods high in protein are linked to hair growth. This includes options like eggs, fish, and avocado. These are all beloved foods anyway, so you should have no problem adding to or keeping these in your diet.
5. Make sure you get enough Vitamin D.
If not, take a supplement. You can find out if your Vitamin D levels are too low through a blood test.
Says Reynolds, "Have your doctor test your iron and thyroid levels at the same, because low levels can contribute to hair loss. As we head toward fall, with a reduction in sunlight, our Vitamin D levels will naturally fall and we can expect to see more shedding. Try to spend at least 10 to 30 minutes a day in the midday sun several days a week."
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Aly Walansky is a NY-based lifestyles writer who focuses on health, wellness, and relationships. Her work appears in dozens of digital and print publications regularly. Visit her on Twitter or email her.