This far into the pandemic, we’re all familiar with the symptoms most often associated with COVID-19 – fever, aches, shortness of breath, loss of smell and taste. But there are other symptoms, too. Including one that’s cosmetic – yet deeply concerning to lots of people: Hair loss.

The New York Times and other news organizations said that doctors have seen a significant increase in patients losing their hair, in part because extraordinary stress of life during a pandemic.

Dr. A Daniel
Dr. Alyssa Daniel

Dr. Alyssa Daniel, of Novant Health Dermatology - SouthPark answered our questions about one of the more recent revelations about a virus that continues to surprise researchers.   

COVID is causing so many ills – both catastrophic and relatively minor. I hear one of them is stress-related hair loss.

Telogen effluvium is a  form of temporary hair loss that occurs when the body is under some kind of stressor. It can happen during pregnancy or post-partum. It can also happen during or after a viral illness. We have seen it in people who’ve been sick with the flu, for instance. The condition can be triggered by certain medications.

Is this alopecia? Or a different condition?

Alopecia just means “hair loss.” It’s a generic term and not a diagnosis. Telogen effluvium is a kind of alopecia.

So, telogen effluvium can be a symptom of COVID-19, but it can also be a symptom of garden-variety stress?

Telogen effluvium can come from an illness or from chronic stress. Stress can be toxic. And pandemic living is stressful. Just living in these times can be enough to trigger it.

If hair loss is related to an illness, it probably won’t happen right away – not during the illness. When a patient comes to me for hair loss, I ask, “What was going on in your life three months ago?” That’s usually when they say they had the flu or some other illness.

Who’s affected by it?

Anyone can be – men, women and children. It impacts people of all racial and ethnic backgrounds. I see more women in my practice. It’s actually about 90% women and 10% men. It’s not that men don’t have the condition. They just don’t tend to see a doctor about it. Women tend to have longer hair than men, and they notice when it’s clogging the shower drain or all over the bathroom floor.

How does the hair fall out? Where do people notice it?

Telogen effluvium is triggered when some stressor causes a large number of hairs in the growing – or anagen – phase of the hair cycle to go into the resting, or telogen, phase.

Noticing it sort of depends on what your hair density is like to begin with. Just thinking of generic numbers, one person might have 500 hairs in the same place on the scalp another has 200 hairs. If both of them lose 100 hairs, the person who started with 200 is really going to notice it. So, noticing it depends on what percentage of hair someone lost.This is normal and gradual and something you wouldn’t notice.

Are we talking about just the hair on our heads? Or can it affect body hair, like eyebrows?

Just the scalp, really. It doesn’t affect other areas so much. It usually occurs at the frontal hairline and around the temples.

How do you treat it?

We always want to treat the underlying cause. If a patient comes in for hair loss and tells me she’s stressed, I want to find out the source of her stress. I’ll ask about her diet and how much protein she’s getting. A complete nutrition history may be important to getting at the cause.I often recommend Nutrafol, a vitamin that improves hair growth. I recommend gentle haircare products, washing every other day if you can stand it, using less heat and styling tools.Rogaine foam solution can help; you apply it once a day. There’s a myth that once you start using Rogaine, you have to use it forever. It’s not true in the case of telogen effluvium. You can stop using it once the hair has grown back. And it does grow back.

Is there a way to prevent it?

I always talk to my patients about wellness. A good diet, sleep, stress management, getting exercise – all of these are good for you overall. That includes the health of your hair and skin.

Are there other skin conditions you're seeing related to COVID-19?

There are some documented cases, through the American Academy of Dermatology, of viral-related rashes and “COVID toes” – when the toes swell and turn pink or purple.

What should someone do if they’re experiencing hair loss?

Try to work through what the organic causes could be with your primary care physician. It’s harder to get in with a dermatologist. I operate a hair loss clinic every Tuesday for a half a day, and I’m booked several months in advance. Your primary care doctor can check your thyroid and iron, which I find to be good initial tests, and also do a medical and diet history. He or she may recommend an iron supplement if your iron is low, correct underlying thyroid abnormalities or refer you to a nutritionist if diet is an issue. If those initial steps don’t yield the results you are looking for, then it’s time to see a dermatologist.

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