Theresa Cabrera was so ill with COVID-19 that she had to spend a month in the hospital this spring, much of that time sedated, intubated and on a ventilator.
When she finally improved and was able to go home in May, the first thing she did was take a shower. That’s when she noticed her hair falling out.
“It came out in my hands — still does,” Cabrera, 54, who lives in Lake Hopatcong, New Jersey, told TODAY. “I was freaking out… Now, when I make a pony tail, it’s less than a quarter of what it used to be. It’s horrible.”
She’s not alone. More than a quarter, or 27%, of patients recovering from COVID-19 reported hair loss as one of the lingering problems in a survey of more than 1,500 people in the Survivor Corp Facebook group. Members are sometimes called “long haulers” because they discuss long-term effects of the disease.
Doctors say telogen effluvium is to blame, a temporary condition where people experience excessive hair shedding after an illness, surgery, high fever, a stressful life event, extreme weight loss or giving birth.
Dr. Esther Freeman, who directs the Dermatology COVID-19 Registry — a database of dermatologic manifestations of COVID-19 that now contains 1,000 cases from 38 countries — said there’s been a growing number of hair loss cases recorded. She declined to give specific numbers while researchers were actively working on a data analysis of the phenomenon.
The timing of an uptick now is not surprising since people with telogen effluvium usually start to see the hair loss about three months after getting sick or the stressful life event, which coincides with about three months since the peak of the pandemic, she noted.
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Like Cabrera, patients have been alarmed.
“If you’re recovering from COVID and then all of a sudden your hair starts to fall out, it can be extremely emotionally distressing,” said Freeman, director of Global Health Dermatology at Massachusetts General Hospital in Boston and an assistant professor of dermatology at Harvard Medical School.
But doctors are seeing a lot more telogen effluvium in general — regardless of illness status — because most everyone has been deeply stressed this year, whether by worrying about catching coronavirus, adjusting to life in quarantine or dealing with a job loss.
Dr. Marc Glashofer, a hair loss expert with The Derm Group in West Orange, New Jersey, has recently noticed an overall increase in telogen effluvium cases at his practice.
“When I see somebody who has shedding, I don’t ask about daily stress like your job or traffic. We’re talking about big stress like the death of a loved one, change in career, a divorce and COVID — COVID is a big stress,” Glashofer said.
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What is telogen effluvium?
Hair has a growing and resting phase, with about 90% of hairs in the growth cycle at any given time.
But when the body is under stress, it goes into a “conservation type mode,” shifting the hair cycle so that more strands get pushed into the resting phase, leading to more shedding, Glashofer noted.
“Hair is important to us cosmetically, but our body — when we have a fever or are significantly ill — doesn’t care about the hair,” he said.
So while it’s normal for people to shed 100-150 hairs a day, telogen effluvium means hundreds might fall out. Glashofer has had patients come in with a “bag of hair” they collected — from the bathroom drain or their hairbrush — to show him the extent of hair loss.
It’s all-over shedding, rather than in one place, so Cabrera hasn’t noticed any bald patches, but complained her hair was very thin. She called her ordeal with COVID-19 “very overwhelming and very stressful.”
Beyond the shock of the disease, is there something about the new coronavirus that may specifically cause or contribute to the hair loss? It’s truly hard to know, so some direct viral effect can’t be ruled out, Freeman said.
“But I would say that given that we’re seeing this huge amount of telogen effluvium in patients who didn’t have COVID, there’s also a lot of stress involved,” she noted.
Some research has suggested male pattern baldness was associated with a higher risk of having the severe form of COVID-19, but Freeman was skeptical and wasn’t convinced of a link. Older men are more likely to get severe COVID-19 and they’re also more likely to have male pattern baldness so it’s very hard to separate those effects and more data is needed, she said.
Hair will return
Patients can be reassured that hairs shed due to telogen effluvium are not permanently gone — they will get pushed back into the growth cycle over the next weeks to months, Glashofer said.
Often the first sign of regrowth will be the appearance of short little hairs at the front hair line, Freeman said.
A doctor might order blood tests to verify there are no thyroid abnormalities, or low iron or vitamin D, all of which can also cause rapid shedding.
Telogen effluvium is painless, and doesn’t involve itchiness or scaling of the scalp, so if any of those other symptoms accompany the hair loss, it should be evaluated by dermatologist.
If there is ongoing stress, hair may take longer than six months to come back to normal. Like many COVID-19 survivors, Cabrera — who described herself as going “1,000 miles per hour” before the illness — continues to grapple with its aftermath. She still can’t walk 10 steps without being out of breath and hasn’t been able to return to work.
People who didn’t become ill are also still navigating problems like financial hardship and other worries. Such lingering anxiety can prolong the effects of telogen effluvium, Freeman said. It’s important to eat a healthy and balanced diet, get adequate rest and manage stress, she added.
Taking biotin won’t help, but PRP, or platelet-rich plasma, may be an option to speed up the regrowth process, Glashofer said.
The bottom line: Don’t panic, the hair will come back to normal on its own.