While we’re still learning about the long-term effects of the novel coronavirus (COVID-19), we’re also beginning to see more tangential consequences the virus causes even for those who don’t contract it.
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Among the more recent signs that doctors are seeing is an increase in visits to dermatologists for stress-related hair loss. While the hair loss isn’t a direct result of having COVID-19, the stress of, well, everything about this pandemic is contributing to the increase.
To learn more about how stress causes hair loss, the COVID-19 effect and what you can do to help slow and reverse this hair loss, we spoke to dermatologist Shilpi Khetarpal, MD.
Understanding stress and hair loss
If you’ve ever found yourself shedding more hair than you’re used to, you’re hardly alone. “There’s a common form of hair loss called telogen effluvium,” according to Dr. Khetarpal, “which is essentially when you get excessive hair shedding.”
Several factors can contribute to this condition, she says, including surgery, general anesthesia, physical or psychological stress, high fevers, weight loss, diet change or even hormonal change such as after childbirth or during menopause.
“If you’re deficient in certain nutrients like iron or Vitamin D, that can cause this shedding, as well as certain medications or even an underlying thyroid condition,” Dr. Khetarpal adds.
In other words, there are a lot of reasons you may be finding more clumps of hair than usual. But it’s also important to understand exactly what’s happening when you’re shedding those follicles.
“At any given time, about 90% of our hair is growing, about 5% is resting and 5% is shedding,” Dr. Khetarpal says. “But when you have a major stress event or shock, up to 50% of hairs can be pushed into the shedding phase.”
It might take a while, too, to start noticing the effects as she says it could take up to two or three months after the inciting event for the shedding to start. And you might not even notice at first as there’s no itching or pain in the scalp.
“The scalp looks totally normal,” she says, “you’re just going to see a lot more hair when you wash or brush your hair or maybe on your clothes or pillow.”
Most cases, she says, resolve within six months but it’s not unusual to hear from patients before that much time has passed because of the added emotional stress that can come from hair loss.
“There’s a huge cultural component to hair, it’s part of our identity,” Dr. Khetarpal points out. While she believes it affects both men and women equally, she says she typically sees more women patients than men.
“It’s part of our identity and how people perceive us. When people start losing their hair, especially for the first time, it can be very emotionally distressing and upsetting to them,” she adds.
COVID-19 and even more stress
So what role does COVID-19 play in all of this? If you contract the virus, Dr. Khetarpal says that it’s certainly a small side effect you could see. “Whether someone has COVID-19, the flu or strep throat, any kind of illness or fever can cause this change in the hair,” she notes.
But, again, you don’t have to be sick to be affected. This form of shedding can absolutely affect those who find themselves stressed out by the pandemic.
“There’s a lot of stress associated with the pandemic,” Dr. Khetarpal acknowledges. “There are financial stressors and people are losing their jobs. There’s the emotional stress of not having social interaction or having to go to the grocery store or someone’s family member getting sick. Any kind of physical, emotional stress can also contribute to this or cause it.”
And if you were already stressed before the pandemic? “That stress can compound on itself and make it worse,” she says.
As disconcerting as it can be, Dr. Khetarpal says that’s also a treatable condition. “Those hairs that were shed are replaced with new healthy hair. People might feel like their hair is thinner but, eventually, their hair density goes back to normal, assuming the hair loss isn’t from medication or a nutritional deficiency.”
Still, people who experience this sudden hair loss might be concerned about what’s happening and want to know what they can do to help curb it and get their growing back to normal. “Usually, I tell people to manage their stress,” Dr. Khetarpal says, “but, obviously, there are things going on right now that we can’t control.”
Exercise and a well-balanced diet that includes a lot of protein are ways to help combat this type of hair loss, she adds, and make sure you’re drinking plenty of water.
But if the hair loss is severe or your hair isn’t coming back in like it should, there are other avenues you can explore in conjunction with your health care provider.
Minoxidil is a topical solution or foam that can help regrow hair by being applied directly to the scalp. It works, Dr. Khetarpal says, by pushing hair into the growing phase instead of resting or shedding. While there are several different forms in which you can acquire minoxidil, Rogaine is probably the most well-known brand.
“It’s safe for most people,” she says. “The only time we don’t recommend using it is during pregnancy or when you’re nursing.”
Besides a multivitamin, taking certain vitamin supplements can also help boost key nutrient levels that promote hair regrowth, Dr. Khetarpal says. One of these is biotin, a water-soluble B-vitamin, and she says 3-to-5 milligrams a day can help.
That extends to other vitamins, too. “If someone is deficient in vitamin D or iron, we know that their hair can shed. So that’s why we say that with a multivitamin, you can make sure you’re getting enough nutrients that you need for your hair.”
Checking with your healthcare provider
There are additional options, too, including oral medications and a process by which platelets are taken from a patient’s plasma and injected into their scalp to boost hair regeneration. But these are all options that should only be explored with the support of your healthcare provider.
“We start with the simplest things first,” Dr. Khetarpal says. “We’ll make sure that the patient isn’t deficient in any nutrients or vitamins. Then we might recommend minoxidil if their a candidate and move on from there. So we start with those easy things and we can add things on.”
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