Losing your hair can be another consequence of the pandemic
Annrene Rowe was getting ready to celebrate her 10th wedding 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.
“I was crying hysterically,” said Rowe, 67, of Anna Maria, 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 seeing many 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, many patients recovering from COVID-19 are
experiencing hair loss — not from the virus itself but from the
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 were weeks when Khetarpal didn’t see a
single patient with hair loss of this type. Now, she said, about 20 such
patients a week come in. One was a woman having difficulty
home-schooling two young children while also working from home. Another
was a second-grade teacher anxiously trying to ensure that all her
students had computers and internet access for online instruction.
In a July survey about post-COVID symptoms among 1,567 members of a
survivors’ group, 423 people reported unusual hair loss, according to
the group, Survivor Corps, and Natalie Lambert, an associate research
professor at Indiana University School of Medicine, who helped conduct
the survey.
Dr. Emma Guttman-Yassky, the incoming chair of the dermatology
department at Mount Sinai’s Icahn School of Medicine, said she has
treated many front-line medical workers 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 the pandemic seems to be triggering, experts say.
In one condition, called telogen 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. Sara Hogan, 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, but if stressful situations persist or
recur, some people develop a chronic shedding condition, Hogan said.
The other hair loss condition that is increasing now is alopecia
areata, in which 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-Yassky said that she has seen “a huge increase in this type of alopecia.”
Not all of the patients had COVID-19, she said, but the ones who did
tended to progress very quickly from one or two bald patches to “losing
hair all over the body,” including eyebrows and eyelashes. She said
that might be because the storm of inflammation that some COVID patients
experience elevates immune molecules linked to conditions like
alopecia.
Experts don’t know exactly 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.
The hair loss itself can cause more stress, Khetarpal said,
especially for women, whose hair is often more closely tied to identity
and self-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 COVID-19 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 growing much
because she wasn’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.
When she came home from 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 recommend good nutrition, vitamins like biotin and
stress-reduction techniques like yoga, scalp massage or mindfulness
meditation. Some also recommend minoxidil, a hair growth drug, but Hogan
warns patients that it can initially cause more hair loss before it
starts working.
With alopecia areata, Guttman-Yassky said, some cases resolve
without treatment and some are helped by steroid injections, but some
can become permanent, especially if not treated early.
For people depressed or traumatized by hair loss, Jafferany
recommends psychotherapy but not necessarily medication because some
antidepressants and anti-anxiety medications can exacerbate hair loss.
When Liz Weidhorn, 44, of Fair Lawn, New Jersey, who tested positive
for COVID-19 in March, noticed members of an online COVID group
bemoaning hair loss, she told herself that if it happened to her, “I
will take it with grace, and I’ll get a kick-ass hat,” she recalled.
But recently after showering, “I looked at my wet hair, and I could
see so much scalp,” she said, “and I couldn’t believe how emotional I
got.” She cried and called her husband in to look at it.
“It’s really shocking,” she said. “It got me very sad.”
Weidhorn, who writes a blog about baking pastry, started taking
biotin, had her mother cut her hair and is considering getting a
headband.
Rowe, who managed the front desk for a wellness spa, has gone further.
“I tried putting my hair in one of
those messy buns, but it looks terrible with the bald spots on the
sides,” she said. So she got wigs: “a really short pixie one, a pageboy
one, a long curly one and a strawberry blonde one,” she said. “I’m
trying to make the best of it.”
Hogan said some patients find the
situation so upsetting they avoided washing or brushing their hair
because they noticed the hair loss more during those activities. She
tells them they shouldn’t be afraid of normal grooming.
She added, “Patients don’t like this when I say this, but they come around to it: Hair is not crucial for your survival.”