Each week, we answer "frequently asked questions" about life during the coronavirus crisis. If you have a question you'd like us to consider for a future post, email us at goatsandsoda@npr.org with the subject line: "Weekly Coronavirus Questions."
I had COVID-19 months ago. Now my hair is falling out! What is going on?
First of all, don't panic! Losing fistfuls of hair may seem alarming, but it's actually a common response to extreme stress, both physical (i.e., an illness such as COVID-19) and emotional (i.e., living through a pandemic).
Given the number of us who have experienced either the physical or emotional stress of COVID, it's no surprise that the number of people who have been Googling hair loss has skyrocketed, according to The New York Times, or that a recent study published in The Lancet showed that 22% of hospitalized COVID-19 patients in China reported hair loss six months later.
In fact, this type of stress-related hair loss, officially called telogen effluvium, may happen more often than we think, says Dr. Aurora Pop-Vicas, an infectious disease specialist at UW health in Madison, Wisc. We could be noticing it now because so many of us are hyper-aware of COVID-19 and its symptoms. In the past, someone who stayed in bed with the flu for four or five days and then noticed clumps of hair falling out three months later might never have made the connection between illness and clogged drain, she says.
"I think this is coming to our attention more than before," she says.
But why do our bodies often punctuate a stressful event with such an insult?
Dr. Greg Vanichcakhorn, the medical director of the COVID Activity Rehabilitation Program at the Mayo Clinic in Rochester, Minn., says it's more accurate to think of it as hair shedding.
"Basically what happens is when a human is exposed to a significant insult like infection or a super-stressful event, it can cause hair cells to go into their dormant phase," he explains. "They're basically dead. And that can happen months after the insult. So maybe why patients are experiencing it post-COVID is that their body is still freaked out about what happened to them."
Hair goes through this cycle under normal circumstances as well, points out Dr. David Cutler, a family medicine physician at Providence Saint John's Health Center in Santa Monica, Calif.
"It's a natural phenomenon that all hair follicles go through periods of rest and growth and hair will fall out," he says.
The difference in people with telogen effluvium is that it all happens at once. Under normal circumstances, about 10% of your hair is in a resting phase, 5% in a shedding phase and the rest in a growth phase, Pop-Vicus says. "But if your body experiences a potent stressor, the body shifts its energy to focus and prioritize life-sustaining function," she explains. "Hair growth is not necessarily a survival function. So then maybe 50% of your hair would shift to the resting phase. That phase usually lasts two to three months, and then it naturally sheds."
That's when patients notice the clumps of hair on their brushes, she says — way more than what you'd usually experience.
That delayed reaction makes it tricky to parse out whether the phenomenon could be associated with COVID long haulers. While it's not one of the primary symptoms or complaints of long haulers, Van has seen cases of it in his patients.
And there are other reasons for hair loss: Medications such as chemotherapy and aging are well-known causes, but sometimes thyroid disease, hormonal imbalances or scalp problems can be the root of the issue, Pop-Vicus says. Contacting your primary care provider can help parse that out.
If you're still noticing clumps after six months, or if you have other symptoms such as scalp itching, redness, flaking or pain, those are signs that something else could be causing the hair loss. Seek out a board certified dermatologist, says Dr. Shilpi Khetarpal, a dermatologist at the Cleveland Clinic.
Whatever the cause, sudden hair loss "can be quite disturbing," Van says.
The good news? Your hair will grow back! With no interventions, telogen effluvium usually resolves within six months, Khetarpal says.
In the meantime, techniques to manage stress may help, says Pop-Vicus: like yoga and meditation, especially when combined with good nutrition, sleep and exercise.
And those who've experienced this symptom also advise family members and friends not to make light of it. "My hair loss was traumatic because as a woman so much of my femininity and self-image is linked to my air," says 44-year-old restaurateur Genevieve Villamora of Washington, D.C. She says her hands were covered with hair after she showered — and that hair would come out during the day as well. The only other time she experienced that degree of hair loss was after giving birth. Her hair loss started to lessen, she says, four months after her recovery from COVID.
Sheila Mulrooney Eldred is a freelance health journalist in Minneapolis. She's written about COVID-19 for many publications including Medscape, Kaiser Health News, Science News for Students and The Washington Post. More at sheilaeldred.pressfolios.com. On Twitter: @milepostmedia
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