By Alan J. Bauman, MD, ABHRS
We can all agree that 2020 has been a stressful year – and unfortunately isn’t showing signs of letting up anytime soon. There’s plenty of “stress” to go around: concerns for our health and the health of our loved-ones, our financial health, changes in work or school from home, impacts to our lifestyle including our nutritional habits, exercise regimens, sleep, social isolation and distancing, as well as disruption in our self-care routines, all have significant implications for us, our communities and nearly everyone around the globe.
But did you know that this stress could affect your hair? That’s right, it’s no myth that increased levels of stress can severely impact our follicles. This effect is due in part to our body’s survival mechanisms, especially elevated cortisol, and our body’s response to them. Prolonged or severe psychological or physiological stress can lead to hair problems such as sudden excessive shedding and accelerated hair thinning, as well as trigger or exacerbate inflammatory problems like dryness, flaking, and types of dermatitis of the scalp – especially if there are underlying scalp and hair loss conditions.
In addition, many recovering COVID-19 patients are reporting “shock hair loss,” a “dread shed,” with hair literally falling out “in clumps” as a lingering symptom. In fact, according to one recent survey of the members of the “Survivor Corps” Facebook Group, 26% of patients experiencing long-term symptoms, often called #longhaulers, report suffering from some degree of hair loss.
COVID-19 & Hair Loss
What we know is that if you have any prolonged fever-related illness, the normal cycling of your hair follicles can be disrupted and shedding can occur. This synchronized shed after a fever called post-febrile telogen effluvium was first described in the medical literature around the time of the end of World War I with the outbreak of the Spanish Flu. In 1919, Hazen called the condition post-influenzal alopecia in a report in JAMA. Shedding starts about two to six weeks after the onset of fever, peaks about six to eight weeks later, and lasts typically another eight weeks. He also noted that patients never seem to go “completely bald” and generally hair growth returns.
We’ve all heard about the COVID-19 “cytokine storm” that does damage to many organs. Prominent hair follicle biology researcher at The University of Miami Miller School of Medicine, Dr. Ralf Paus, believes that these same elevated levels of circulating cytokines are the ones that interrupt hair follicle function.
Just like an infection with fever can trigger shedding or telogen effluvium, similar shedding can occur during other stressors like the loss of a job, divorce, or death in the family. The good news is that stress or infection alone doesn’t cause permanent hair loss. What we do see however, is that underlying conditions can sometimes be revealed, triggered, or accelerated when there is a “shock” to the hair follicle cycling.
Contributing factors to more permanent hair loss range from genetic predispositions to baldness, to certain health and lifestyle risk factors that may already be stressing on the hair follicles (e.g., illness, hormonal sensitivity like male or female pattern hair loss, hormonal imbalance, lack of sleep, certain medications, poor nutrition, smoking, etc.).
Hair loss or shedding resulting from the physical or emotional stress of COVID-19, assuming the follicle is still functioning, should resolve on its own. Many patients should see the shedding stop and improvements beginning around 8 weeks, but in some cases, it could take anywhere from 6 to 10 months for the hair volume to return.
Taking Care of ‘Stressed Tresses’
No one will ever be able to eliminate every bit of stress from their lives, and certainly not during these stressful times, but it’s important for patients to pay close attention to their overall health and the health of their hair. If you notice excessive shedding, it may be time to meet with a board-certified Hair Restoration Physician, certified HairCoach®, or a qualified Trichologist. Beyond what a standard dermatologist can offer, these professionals can evaluate your hair loss situation and risks, scientifically evaluate your scalp, offer advanced supportive or hair regrowth treatments, as well as quantitatively measure and track not just the baseline of your hair loss status at the moment but also monitor your hair regrowth over time – so there’s no guessing whether a treatment is working and your situation is improving.
For some patients, reversing problematic hair may simply come down to treating the hair shedding symptoms for a period of time using an over the counter product like INTACT which contains an organic ingredient that increases the amount of force required for hair fall-out. Rectifying nutritional intake by sticking to a healthier diet, and adding a hair-specific supplement like Nutrafol which contains anti-inflammatory and stress-adaptogen components; or it may include a “Scalp Makeover” by our salonB trichologist, which utilizes a scientific evaluation of the scalp and then a custom therapeutic regimen that might include a stress-reducing and circulation-stimulating scalp massage, scalp steaming and application of highly advanced topical therapeutic products to boost the health of the scalp and follicles. For other patients with underlying hair loss conditions, more advanced therapies such as at-home low-level laser therapy, in-office platelet-rich plasma (PRP) or at-home “VirtualPRP” using growth factors and cytokines, or prescriptions for compounded Formula 82M minoxidil and Fin.481 finasteride may be appropriate.
It is important to know that hair loss or other hair problems caused by stress, whether emotional or physical, can be particularly difficult to self-diagnose. A temporary hair loss episode doesn’t usually happen immediately following the stressful period or triggering event – it often happens weeks, or even months afterwards. This means that you may not see the impact that COVID-19 has on your hair until one or maybe even two months later.
To properly diagnose the cause of your hair loss or thinning, or other serious hair or scalp problems, it is important to be evaluated by a board-certified hair restoration physician, who can accurately measure and evaluate your situation–helping determine if your hair loss is in fact due to stress, or if it is a symptom of a more serious underlying health condition.
For more information on COVID-19 related hair loss, or to learn more about the newest hair restoration treatments available, please visit www.baumanmedical.com or call 561-220-3480.
What Patients Can Expect at Bauman Medical’s “COVID-Protected” Hair Transplant Facility:
We continue to vigilantly screen our staff for ANY health issues.
We are pre-screening patients in advance of their arrival to the office.
We are screening patients when they arrive, including temperature checks and symptom screenings.
We conduct COVID testing for patients and staff when necessary.
We are limiting the number of patients in our facility, especially in waiting areas, to maintain social distancing.
All visits are by appointment only; no walk-in appointments will be accepted at this time.
All patients are required to wear a mask and all of our staff will be fully equipped with the appropriate protective gear.
As we have done since the beginning of this situation, we continue to meticulously sanitize our facility frequently throughout the day, including disinfecting all surfaces, equipment, and seating areas before and after each patient, and performing our extensive UV-light Sanitization and Deep Cleaning Protocols on a nightly basis.