Losing your hair can be another consequence of the pandemic
Annrene Rowe was getting ready to celebrate her 10thwedding anniversary this summer when she noticed a bald spot on her scalp. In the following days, her thick, shoulder-length hair started falling out in clumps, bunching up in the shower drain.
“Iwas crying hysterically,” said Rowe, 67, of AnnaMaria, Florida.
Rowe, who was hospitalized for 12 days in April with symptoms of the coronavirus, soon found strikingly similar stories in online groups of COVID-19 survivors. Many said that several months after contracting the virus, they began shedding startling amounts of hair.
Doctors say they too are seeingmany more patients with hair loss, a phenomenon they believe is indeed related to the coronavirus pandemic, affecting both people who had the virus and those who never became sick.
In normal times, some people shed noticeable amounts of hair after a profoundly stressful experience such as an illness, major surgery or emotional trauma.
Now, doctors say, manypatients
recovering from COVID-19 are experiencing hair loss — not from the virus itself but fromthe physiological stress of fighting it off. Many people who never contracted the virus are also losing hair because of emotional stress from job loss, financial strain, deaths of family members or other devastating developments stemming from the pandemic.
“There's many, many stresses in many ways surrounding this pandemic, and we're still seeing hair loss because a lot of the stress hasn't gone away,” said Dr. Shilpi Khetarpal, an associate professor of dermatology at the Cleveland Clinic.
Before the pandemic, there wereweekswhenKhetarpaldidn't see a single patient with hair loss of this type. Now, she said, about 20 such patients aweek come in. One was a woman having difficulty home-schooling two young childrenwhile alsoworking from home. Another was a secondgrade teacher anxiously trying to ensure that all her students had computers and internet access for online instruction.
In a July survey about postCOVID symptoms among 1,567 members of a survivors' group, 423 people reported unusual hair loss, according to the group, SurvivorCorps, andNatalie Lambert, an associate research professor at Indiana University School of Medicine, who helped conduct the survey.
Dr. EmmaGuttman-Yassky, the incoming chair of the dermatology department atMount Sinai's Icahn School ofMedicine, said she has treated many front-line medicalworkers for hair loss, including her hospital's employees.
“Some of them had COVID, but not all of them,” she said. “It's the stress of the situation. They were apart from their families. They worked for many hours.”
For most patients the condition should be temporary, doctors say, but it could last months.
There are two types of hair loss thepandemicseemstobe triggering, experts say.
Inonecondition, calledtelogen effluvium, people shed much more than the typical 50 to 100 hairs per day, usually beginning several months after a stressful experience. It essentially involves a shifting or “tripping of the hair growth system,” said Dr. SaraHogan, a dermatologist at the David Geffen School of Medicine at the University of California, Los Angeles, who has been seeing up to seven patients a day with the condition.
In healthy hair cycles, most hairs are in a growing phase, with a small percentage in a short resting phase and only about 10% of hairs in a shedding or telogen phase. But with telogen effluvium, “people are shedding more, growing less,” Khetarpal said, and up to 50% of hair might skip ahead to the shedding phase, with only about 40% in the growth phase.
The phenomenon, which some women also experience after pregnancy, typically lasts about six months, butifstressfulsituationspersist or recur, somepeopledevelop a chronic shedding condition, Hogan said.
The other hair loss condition that is increasing now is alopecia areata, inwhich the immune system attacks hair follicles, usually starting with a patch of hair on the scalp or beard, said Dr. Mohammad Jafferany, a psychiatrist and dermatologist at Central Michigan University.
“It is known to be associated with or exacerbated by psychological stress,” Jafferany said.
Guttman-Yasskysaidthatshe has seen “a huge increase in this type of alopecia.”
Not all of the patients had COVID-19, she said, but the oneswho did tended to progress
very quickly fromone or twobaldpatchesto“losinghair all over the body,” including eyebrows and eyelashes. She said that mightbe because the storm of inflammation that some COVID patients experience elevates immune molecules linked to conditions like alopecia.
Expertsdon’tknowexactly why stress triggers these conditions, which affect both women and men. It might be related to increased levels of cortisol, a stress hormone, or to effects on blood supply, Hogan said.
Thehair loss itself cancause more stress, Khetarpal said, especially forwomen, whose hair is often more closely tied toidentityandself-confidence.
“It’s your trademark,” said Mary Lou Ostling, 77, a retired educator who lives in the Stuyvesant Town neighborhood of Manhattan. She was hospitalized for COVID19 for eight days in the early spring and later noticed that “my hair started coming out in chunks,” she said. “I always was clearing hair out of the comb, brush, the sink.”
Ostling said she also could tell that her hair wasn’t growingmuch because shewasn’t seeing roots that contrasted with the color she had previously dyed it.
“I’ve always had very long, very thick, very curly hair,” she said.
But in July, she had it cut. “I couldn’t deal with it anymore,”
Ostling said.
Whenshe camehomefrom the hairdresser, she said,“my husband was just staring at me. He said, ‘I think I have a different wife.’ It was very depressing.” She said she has finally begun to detect some hair growth.
Experts recommendgood nutrition, vitamins like biotin and stress-reduction techniques like yoga, scalp massage or mindfulness meditation. Some also recommend minoxidil, ahairgrowthdrug, butHoganwarnspatientsthat it caninitiallycausemorehair loss before it startsworking.
With alopecia areata, Guttman-Yassky said, some cases resolve without treatment and some are helped by steroid injections, but some can becomepermanent, especially if not treated early.
For people depressed or traumatized by hair loss, Jafferany recommends psychotherapy but not necessarily medicationbecausesomeantidepressants and anti-anxiety medications can exacerbate hair loss.
Hogan said some patients find the situation so upsetting they avoidedwashing or brushing their hair because they noticed the hair loss more during those activities. She tells them they shouldn’t beafraidofnormalgrooming.
She added, “Patients don’t like this when I say this, but theycomearoundtoit: Hair is not crucial for your survival.”