Q&A: Hair loss among long-term COVID-19 effects

Some patients with COVID-19 have shown long-lasting effects. Hair loss, also known as telogen effluvium, is not on the CDC’s list of known COVID-19 symptoms but has been experienced by many in the months after diagnosis.

In addition, the stress of the pandemic may cause hair loss in those who have not been infected with the virus.

Healio spoke with Shilpi Khetarpal, MD, a dermatologist at the Cleveland Clinic, about telogen effluvium and how it has presented during the pandemic.

What is telogen effluvium, and how are you seeing it presenting in patients with COVID-19?

Telogen effluvium (TE) is a common form of hair loss characterized by diffuse hair shedding, resulting from the early entry of the hair into the telogen phase.

Inducing factors include systemic diseases, stressful events, drugs, nutritional deficiencies and major surgery. Hair loss occurs 3 months after the causing event and is usually self‐limiting, lasting for about 6 months. There is a delay because there are various phases of the hair cycle. Usually around 85% are in the growing phase, 5% resting and around 10% are shedding. When a person has a major stress event or shock, up to 50% of their hair can be prematurely pushed into the shedding phase.

Regarding patients with COVID, we are seeing them present 3 to 4 months after the illness with shedding. We are also seeing people dealing with TE who did not have COVID. There is immense stress around the pandemic itself. People are stressed regarding finances, child care, homeschooling and fears about contracting COVID, along with everyday life stressors. In my practice, I have seen a rise in patients with TE since early June and continue to see new patients every week complaining about excessive hair shedding.

Shilpi Khetarpal

Why is this something that can occur in patients with COVID?

Any kind of stress to the body, whether it is fever or an illness, creates stress. We see telogen effluvium with many illnesses, and COVID is no exception.

How long can someone expect to see this happen?

TE typically starts 2 to 4 months after the inciting event and can last up to 6 months. In most cases, it resolves on its own.

What risk factors do patients who are experiencing telogen effluvium after COVID infection have?

Experts say it is hard to know why some patients recovering from COVID lose hair and others do not. It may be related to genetics. We know that hair loss happens to people who are predisposed, but we do not know who or why. There are specifics about one’s hair cycle and genetics that make them prone or predisposed to developing TE.

What can be done to combat this issue?

Time. The majority of TE cases resolve within 6 months. For those who want to speed up the process, topical minoxidil applied once daily can be helpful, as long as the patient is not pregnant or nursing. Eat a well-balanced diet with adequate protein. A daily multivitamin can also help ensure the patient has the building blocks needed for optimal hair growth. Try to minimize stress by doing exercise, yoga or meditation.

When should someone with TE contact a medical professional?

TE and hair loss in general can be stressful. It can affect one’s quality of life. It is important to seek medical attention from a board-certified dermatologist if hair loss is not improving after 6 months or if the patient is concerned about it. With TE, the scalp appears completely normal. There is no rash, flaking or itching. If someone has those symptoms, there could be something else going on.