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Based on our knowledge, previous studies were case reports or case series [10, 11]. CCCA and LPP fall under the umbrella of lymphocytic scarring alopecia. The telltale signs of these conditions are chronic inflammation of the scalp and the scarring of hair follicles, which can result in irreversible hair loss, Agbai notes. The virus is thought to reach the skin through blood vessels facilitated by the presence of ACE2 receptors in the endothelium. This could be another way the SARS-COV2 could impact the hair follicles.
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Doctors aren’t sure why only some people develop these unusual symptoms. Genetics might play a role, Dr. Mulligan said; vaccination status could also have something to do with it, as an unvaccinated person might have a more severe infection, which could generate a different course of symptoms. Scientists have also found that the coronavirus can enter the bloodstream in a minority of people, he said, which means that it’s possible that the virus could enter various organs across the body and cause symptoms beyond the respiratory system. Hair loss due to COVID-19 is likely due to a condition called telogen effluvium. This type of hair loss is hereditary, meaning that you can inherit it from your parents.
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According to the Cleveland Clinic, 50 million people assigned male at birth and 30 million people assigned female at birth in the U.S. experience this type of hair loss, which is largely genetic, although hormones also play a role. Baldness is often hereditary, and is activated by a shift in your hormones. If you’re experiencing elevated levels of the hormone dihydrotestosterone (DHT), your body will respond by shrinking your hair follicles and reducing the length of the hair growth cycle, according to Cleveland Clinic. Since November 2021, almost two years have passed since the beginning of the novel coronavirus disease 2019 (COVID-19) pandemic. Studies have revealed that more than one-third of patients with COVID-19 develop a range of persistent symptoms after the acute phase of the infection [1-2].
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Acute TE is a self-limiting disorder that usually lasts for about six months, after which it usually goes into remission [6]. In the telogen phase, hairs rest for 2 to 3 months before being shed from your scalp to allow for new hair growth. This is why hair loss due to TE happens so long after a triggering event, such as an illness or highly stressful period. The cytokines had higher levels in severe COVID-19, according to previous studies. The higher levels of cytokines may have a relationship with a higher risk of TE.
Alopecia areata can be exacerbated by other health conditions, including COVID-19, but this is not the type of hair loss most people are experiencing after the virus. Traction alopecia is the result of environmental factors, such as wearing your hair in tight hairstyles, Agbai says. Telogen effluvium refers to the excessive shedding of hair follicles, and it occurs when hair follicles prematurely skip to the end of the hair growth cycle, she adds. The alopecia had spread diffusely, and there were no prominent alopecia spots; thus, we suspected the condition to be telogen effluvium (TE).
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The patients who suffer from TE are anxious and usually worry about their hair. Therefore, TE has a dramatic impact on their psychological health and mind [2]. TE results from an abnormal hair cycle in which the growing phase decreases, and follicles enter the telogen phase prematurely.
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Telogen effluvium usually doesn’t occur at the same time as the triggering event, though—it starts approximately three months after, Dr. Ziering says. A common symptom of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections was the loss of taste and smell. First of all, the sample size was limited and the study is only retrospective. Based on our knowledge, this is the first cross-sectional study investigating TE triggered by COVID-19 in Iran. TE can occur as a result of hydroxychloroquine, azithromycin, or other drugs used in COVID-19 treatment. The mental and psychological effects of the pandemic are another critical source of stress; therefore, TE may be increased overall [17].
Of the participants, 196 (46.12%) noticed hair loss one to three months after having COVID-19, followed by 119 (28%) who noticed it one week or less after contracting COVID-19. A total of 140 (32.94%) participants suffered hair loss for more than six months after being infected with COVID-19, while in 111 (26.12%) participants, hair loss lasted one to three months. In response to questions about hair loss complaints pre-pandemic and a family history of alopecia, 426 (52.9%) and 539 (66.9%) participants reported not having previous hair loss or a family history of alopecia, respectively. The majority (86%) of the participants who experienced alopecia had not consulted a dermatologist for this problem (Table (Table33). It is characterized by non-scarring, diffuse hair loss from the scalp. It occurs as a reaction to various insults that can be physical, mental, or chemical, resulting in a premature follicular transition from the anagen (active growth phase) to the telogen (resting phase).
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Data were analyzed using SPSS software version 22 using T-test and Chi-square. A new paper published in the Journal of Cosmetic Dermatology sums up what is known about this potentially distressing condition. Among the 806 subjects diagnosed with COVID-19, 490 (60.8%) were females, and 491 (60.9%) were single.
Some symptoms remain and persist throughout the acute and chronic stages, whereas other symptoms newly appear after the acute phase [3-4]. Hair loss is not common in the acute phase of COVID-19 but is a well-known sequela of COVID-19 observed in approximately 20% of these patients [2]. However, only a few case reports have described its clinical course. Herein, we report the case of a patient with post-COVID-19 alopecia that improved and recovered almost to the pre-infection level. This first scoping review shows that hair loss does occur in a proportion of COVID-19 cases, and is mostly reversible. No clear associations were made with COVID-19 severity, but female patients seemed more at risk for alopecia with this condition.
People experiencing female pattern baldness may also notice a general thinning of hair on the top of your head, but hair loss typically won’t occur on the front of your scalp, per Harvard Health. Hair loss is not common in the acute phase of COVID-19, but a sequela of COVID-19 is observed in approximately 20% of the patients [2]. Most cases are TE, secondary to the physical or psychological distress of COVID-19 [6]. Androgenetic alopecia is considered a risk factor for severe COVID-19 (named the “Gabrin sign”) [8]; however, this is not a sequela. The stress of COVID treatment, or pandemic life, can also be a factor in hair loss. Wolf said it’s not surprising that people experience hair loss after having a high fever or being placed on a ventilator during a hospital stay since all are mentally and physically stressful situations.
Of these patients, 79 were male (39.9%), and 119 were female (60.1%). Telogen effluvium (TE) is one of the consequences of the COVID-19 pandemic. COVID-19 leads to more medications and stress situations, which trigger TE. Although our patient received medication for alopecia areata on his request, TE is reversible and expected to improve without any treatment after the psychophysical damage disappears [6].
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The supplementation of iron or zinc can be a treatment option for treating the deficiency of these minerals [9]. Although hair loss is not life-threatening, it can considerably affect the patient’s quality of life; hence, physicians need to provide complete care for such patients [4]. Furthermore, physicians need to reduce anxiety by explaining to patients their conditions, sharing medical information, and eliminating their psychophysical stress by managing various systemic complications. Unfortunately, there are only a few reports, such as our case, wherein the hair loss was recovered to the original state [10].
Dr. John Wolf, chair and professor of dermatology at Baylor College of Medicine, discussed how this can happen and how to manage it. Another unique feature of the effluvium seen post-COVID-19 is the significant overlay of psychoemotional stress. This is unlike any other infection, which leads to telogen effluvium because the ambient stress caused the pandemic itself and contributed to a large extent by the restriction measures taken to prevent the spread of the disease. Telogen effluvium would be one of the important aspects of long COVID, which will impact the quality of life of the affected person. However, the definite mechanisms of hair shedding following COVID-19 infection are not well known and further studies to elucidate the exact mechanisms are required [7]. Although hair loss is considered a benign condition, it can be devastating to a patient’s self-esteem, self-image, and overall quality of life.
The phenomenon is especially common among long COVID patients who continue experiencing symptoms such as fatigue, brain fog and shortness of breath weeks or months after recovering from the initial infection. But long COVID patients are often surprised by the hair loss symptom. This is likely because their bodies are undergoing a significant amount of stress and are still not quite back to normal. Perng reassures patients who experience chronic telogen effluvium that they will not lose all of their hair, because the proportion of telogen hairs never exceeds 50 percent.
Avoid vigorous towel drying and harsh brushing or combing, especially when the hair is wet and more prone to breakage.” If you do want to continue using some heat, a heat protectact and something like a leave-in treatment are both recommended. Alopecia areata is an autoimmune condition that is characterized by “round patches of hair loss on the scalp,” although it can occur elsewhere on the body, Agbai says. While the exact reason for this type of hair loss is unknown, it is generally understood that “the immune system mistakenly attacks hair follicles, leading to hair loss,” she adds.
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