Yet another COVID-19 symptom: hair loss

Many people infected with the virus are experiencing hair loss

As we move through this year, we continue to learn more and more about the impact of the novel coronavirus. Many patients recovering from COVID-19, including actress Alyssa Milano, are experiencing symptoms of hair loss.

Although the Centers for Disease Control and Prevention (CDC) currently doesn’t recognize hair loss as a COVID-19 symptom, providers across the country are seeing more and more patients recovering from COVID-19 experiencing hair loss. The type of hair loss seen in some COVID-19-positive patients is called telogen effluvium, which is a type of hair loss that happens after physical or emotional stress, including fever, illnesses or weight loss. 

What do we know about it?

Although the specific ways this happens aren’t yet known, it is thought that the physiologic stress of fighting off the virus contributes to this hair loss. In telogen effluvium, more of the hair follicles are in the telogen phase of the hair cycle, also known as the “shedding” phase.

Generally, there is a two- to three-month lag between the stressor and the actual hair loss, which could explain why patients are experiencing hair loss several weeks after their COVID-19 symptoms resolve.

Importantly, only having symptoms of hair loss is not an indicator of having the COVID-19 infection; rather, telogen effluvium could be a consequence of COVID-19. Many people who are not infected with COVID-19 have been experiencing hair loss as a result of stressors from the pandemic such as job loss, losing loved ones, and uncertainties stemming from the pandemic. More research needs to be done to learn whether COVID-19 directly causes hair loss.

Symptoms

Telogen effluvium is a non-scarring type of hair loss and is a painless condition. It doesn’t involve itchiness or scaling of the scalp. If any of those other symptoms are experienced with hair loss, it should be further evaluated by a dermatologist.

Is it reversible or permanent?

Typically, people lose up to 100 hairs per day. Telogen effluvium can cause around 300 strands to fall out every day and usually lasts about six to nine months. If the stressful situation persists, experiencing hair loss can occur until the stress resolves.

What can be done?

When managing hair loss, it is important to remember not to be embarrassed about it. Although it can affect self-confidence, this condition can be managed in multiple ways. Someone experiencing hair loss is advised to seek professional help, specifically from a board-certified dermatologist. They will be able to assess for any other underlying causes of hair loss, such as medications used, nutrition or hormone imbalances, or other stressors.

Managing stress

Easing stress is an important component of managing hair loss. Ways of doing this include getting that full eight hours of sleep, taking a socially distanced walk or run outside for at least 30 minutes if able, yoga and/or meditation, and participating in any favorite hobbies. Especially during these times of stress and uncertainty during the pandemic, it is essential to manage stress to improve health as a whole.

Eating a well-balanced, healthy diet is key to overall mental and physical well-being. Intake of protein and vitamins like zinc and iron are important.

Medications that can ameliorate hair loss include minoxidil. Minoxidil increases the anagen or growth phase of hair and can be purchased over the counter. It is best to consult your provider to see if this option is right for you before deciding to use it.

Generally, biotin won’t help make the hair grow back, and taking biotin won’t help with hair regrowth. Other therapies such as PRP, or platelet-rich plasma, could be an option to help with the regrowth process

It is important not to stop washing or brushing if experiencing hair loss. Gentle hair care is key if experiencing hair loss. This includes not using rough ingredients to hair, such as sulfate, parabens, alcohols, fragrances, and dyes in hair products. It is also important to avoid potentially damaging treatments to hair such as dyeing, perms and bleach sessions.

Be aware of changes to any part of your health, both mentally and physically. If you experience any symptoms of fever, cough, sore throat, fatigue, weakness or chest pain, it is important to inform your provider for further monitoring.

Alexis E. Carrington MD is a postdoctoral research fellow at the University of California-Davis Department of Dermatology. She completed her Internal Medicine Preliminary year at Mount Sinai Icahn School of Medicine Elmhurst Hospital Program in New York City, during the peak of the COVID-19 pandemic. She is pursuing dermatology with interests in ethnic and medical dermatology, underserved and global health dermatology, and dermatologic surgery.