July 22, 2020 -- Since getting COVID-19 in March, Juli Fisher, a travel nurse who was caring for COVID patients in an assisted living facility, has dealt with a long list of crippling symptoms herself. Most were ones she expected because they were in line with well-known symptoms. But one was more surprising to her when it emerged several weeks into her illness -- hair loss.
“I started noticing gobs of hair coming out when I took a shower. At first I thought it was that I was using a cheaper shampoo, but it soon became obvious, as more and more came out, that this was something else,” she says.
Once she joined a Facebook group for other “Long Haulers” -- people whose symptoms aren’t going away after a few weeks -- she realized she wasn’t alone. “When I saw others had it, I realized, oh, this is COVID-related, too.”
Rachel Baum of Saratoga Springs, NY, has had COVID symptoms for more than 100 days. Her hair is falling out, too.
“I’ve lost so much hair that I thought my thyroid was out of whack. I went to see my endocrinologist, and she said my numbers were fine. So it has to be COVID or my advanced age of 64, or a combination,” she says. “I have three different wigs in my Amazon shopping cart right now, just in case I need them.”
The link between hair loss and COVID is just starting to be reported and recognized in research. Sara Hogan, MD, a health sciences clinical instructor at the David Geffen School of Medicine at UCLA, says this timeline makes sense because hair loss often happens to patients 3 to 5 months after a stressful illness or experience.
COVID and Hair Loss
The American Academy of Dermatology says hair loss can be caused by genetics, age, hormonal imbalances, other health conditions, medication and, of course, stress. Experts say the type most COVID-19 patients are having is called telogen effluvium, a temporary form caused by a physical or emotional stress, high fever, illness or weight loss of more than 20 pounds -- symptoms common with the virus. Telogen effluvium involves shedding all over the head -- not just on the crown like male pattern baldness -- and it’s far more than the 50 to 100 hairs people typically lose daily.
“There are three common cycles in hair’s life cycle. Up to 90% at any time are growing, 5% are in a resting phase, and up to 10% are shedding. When you have a major stress event or shock, up to 50% of your hair can sprint ahead to the shedding phase, Hogan says.
“That’s usually a delayed process because of the way the hair growth cycle is,” she says. “So you can have this major event, and then it can be about 3 to 5 months later that all of a sudden, you start to notice the shedding. And we're in the time frame for that with regard to the pandemic.”
This type of hair loss is linked to “severe illness, autoimmune disorders, and people who have a stroke or heart attack,” says Gregory A. Poland, MD, an infectious disease expert at Mayo Clinic and spokesperson for the Infectious Diseases Society of America. “This type of hair loss happens when people are immensely stressed.”
Hogan says she expected to see hair loss emerge at this point in the global pandemic. She is now seeing new coronavirus patients every week who have hair loss for the first time. “People are getting sick, losing jobs, and dealing with a lot of uncertainty related to their income and well-being, and I knew that it was going to be significant,” she says.
“Hair loss can occupy a large amount of someone’s mind share because our hair is something we see,” she says. “It’s often part of our identity and how others perceive us. So when patients start losing hair, especially for the first time, they often come to me very upset.”
Experts say another issue could be making the problem worse. COVID arrived in the U.S. at a time when many people already have seasonal shedding known as the “spring shed,” which happens between March and May. “Some people do shed more hair in the spring, and we don’t exactly know why. Some think it's related to a natural, seasonal cycle, and others think it emerges several months after the stress of the winter holidays,” Hogan explains.
Experts say it’s hard to know why some patients recovering from COVID lose hair and others don’t. Hogan says that may be related to genetics. “Hair loss happens to people who are predisposed, and we don't know who that is. There’s just something about some people’s genetic composition and hair cycle that makes it more likely for them.”
What to Do About Hair Loss
While hair loss can affect your self-confidence and self-image, experts urge people not to be embarrassed or try to handle it on their own. Instead, reach out to a health professional. A primary care doctor or dermatologist can rule out other causes like medications, a lack of nutrients, or hormone imbalances, and they can track your daily sleep, exercise, and nutrition habits to see if improvements in those areas could help.
Hogan says you can also talk with your doctor to see if a high-protein diet, more vitamin D, or supplements like biotin would help. Beyond that, she says doctors can help you find out if your stress has triggered anxiety or depression that needs treatment. Sometimes, she says, it also just helps for patients to hear from a medical professional that while hair loss can become a chronic problem, this type usually clears up.
“Most of the time, it does improve,” Hogan says. “I think it’s important to tell patients that in most cases, this is not a permanent hair disorder. It will likely get better within 4 to 6 months. That reassurance and knowledge often does help.”
“This type of hair loss does tend to improve over time,” Poland agrees. “That can be variable -- some may see all their hair return, and for others it may be more spotty. But usually, as the medical illness resolves, hair tends to regrow.”
In the meantime, Hogan urges patients to try to ease their stress if they can. “I oftentimes will discuss stress reduction strategies with my patients,” she says. “I feel like it's crucial, especially if this is stress-induced hair loss, to encourage things that may help their hair and are also good for their overall being, like yoga [or] mindfulness meditation. There is a very holistic approach you can take to optimize your body and health for hair growth.”
If those things don’t work, there are medicines, like minoxidil, that may help. The medicine, which is applied to the scalp, can help regrow hair in some, but Hogan says patients need to research how this medication works before starting it.
“I give patients the option of using minoxidil because it can help with acute shedding, but it’s important to stress that because of its mechanism, patients can actually experience increased shedding when they start using it and when they stop,” she says.
Beyond that, Hogan says, all you can do is practice patience. She tells patients that it took several months for the hair loss to happen, and it will take some time for the problem to go away.
“I am reminding patients that hair is not essential for your long-term survival,” she says. “What really matters is that you made it through a very stressful situation, and you and your body are overcoming that. So barring any systemic issue, you can expect that it should regrow. You just have to give it some time.”
Fisher is still waiting. After more than 100 days dealing with a variety of COVID symptoms, hair loss remains one of them. But, she says, while it is distressing to see it continue to fall out in the shower, it’s not her main concern right now.
“I have super thick hair, so I’m lucky in that way. I haven’t seen a specialist or talked with a doctor about it. I still don’t even have the energy to get up and walk around unless I have oxygen, and I'm scared that I'm never going to work again. I need to figure out what’s going on with my heart and lungs first before worrying about my hair. As upsetting as it is, at this point, maybe I’ll have to start buying scarves or something. But hair loss needs to stay pretty far down on my agenda right now.”