You might not expect a link between COVID-19 and hair loss—the coronavirus causes a respiratory illness, after all. But some survivors are noticing that their hair is falling out during their recovery period.
In fact, Dr. Esther Freeman, who directs the Dermatology COVID-19 Registry, a database of dermatologic manifestations of COVID-19 that contains 1,000 cases from 38 countries, told TODAY that an increasing number of people who are recovering from the coronavirus are reporting hair loss in the aftermath of the illness.
This hair loss is no surprise to infectious disease expert Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security in Maryland, and it's due to a mechanism called telogen effluvium.
“After [experiencing] physiological stress, there is a condition that impacts the growth cycle of hair follicles. It’s called telogen effluvium, and it can be seen after many different types of illnesses, including malaria and tuberculosis,” Dr. Adalja tells Health.
Telogen effluvium typically manifests about three months after the stressful event, and both men and women can be affected, he adds.
Dermatologist Angelo Landriscina, MD, tells Health that this type of hair loss can follow any stressful life event—not only severe illness but also surgery or a serious psychological stressor, like the loss of a loved one. “We’re not talking regular daily stress here,” he says.
To understand telogen effluvium, it helps to understand the hair growth cycle.
“At any given time, 85-90% of our hair is in a phase called anagen—the growth phase,” Dr. Landriscina says. “Meanwhile, 1-2% are in a transitional phase called catagen. Up to 10% of our hair is in the telogen or ‘resting phase,’ which is the phase where our hair is normally shed. In telogen effluvium, a larger than normal portion of our hair moves into the telogen phase and is shed.”
Some amount of hair shedding is normal; the American Academy of Dermatology (AAD) says it's typical to lose 50 to 100 hairs a day. Yet losing “significantly more” than this is considered to be excessive, and results in a diagnosis of telogen effluvium.
While there’s no evidence of a coronavirus-specific mechanism triggering hair loss, any serious illness can cause telogen effluvium—and COVID-19 certainly falls into that category.
“Many people with COVID-19 become severely ill with high fevers and other symptoms, which we know can be linked to telogen effluvium,” Dr. Landriscina says. “We know that the stress hormone cortisol is released at higher levels during severe illness, and we also know that cortisol can affect hair structures.”
Even the psychological stress of contracting the coronavirus can cause telogen effluvium.
“COVID-19 has clearly caused a lot of us stress, and not just physiological stress on the body from an infection,” Kristen Lo Sicco, MD, assistant professor of dermatology at NYU Langone Health, tells Health. “The pandemic has caused many types of stress outside of personal illness, such as financial stress, death of a loved one, and childcare-related issues.”
Economic hardship and racial injustice could also lead to hair loss, Dr. Landriscina adds—and there's been no shortage of either so far in 2020.
Typically, telogen effluvium lasts for up to six months, Dr, Adalja says. It’s basically a waiting game; a person who has had stress-induced hair loss will start to see their hair gradually return to normal as new hair grows.
Patience aside, Dr. Landriscina says that people who are experiencing telogen effluvium can apply a topical minoxidil 5% solution (such as Rogaine). “This encourages hair follicles to leave the telogen phase early and return to the anagen or growth phase,” he explains.
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