COVID, Stress, and Hair Loss
Pandemic stress and COVID infections can lead to increased hair loss
- Many people have experienced hair loss from the mental stress of the pandemic and/or the physical stress of COVID-19 itself.
- Significant hair loss can negatively impact self-esteem and self-confidence.
- Treatment options include stress reduction, oral and topical medications, and hair transplant for those who do not experience an improvement.
Since the start of the COVID-19 pandemic, the degree of hair loss for both men and women has been climbing. This notion was first highlighted in the media by Amanda Mull when she wrote about her experience with hair loss in the article titled The Year America’s Hair Fell Out published in The Atlantic in November 2021. To understand the full implications of pandemic-related hair loss, it is important to review the hair growth cycle and how emotional and physical stress can affect it as well as to understand the psychosocial impact hair loss has on people. Fortunately, there are treatment options available for those with significant and long-lasting changes.
The hair growth cycle has three phases: the growing phase, anagen; the regressing phase, catagen; and the resting phase, telogen. In the scalp at any point in time about 85% of hairs are growing, while about 14% are resting and 1% are regressing. These rates vary for hair at different places on the body. While there are a variety of causes of hair loss, the condition that is responsible for the pandemic hair loss spike is called telogen effluvium. This type of loss can be particularly distressing because of its sudden and dramatic nature. Telogen effluvium can be triggered by any kind of intense physical or emotional stress and can lead to as much as 70 percent of hair going into the telogen or resting phase of its growth cycle. Someone experiencing telogen effluvium might lose three to six times as much hair as would occur with the normal hair cycle. This amount of shedding of hair can lead to noticeable hair thinning and scalp exposure.
Hair loss has been a common consequence for COVID patients whose symptoms resolve in a couple of weeks and for those who develop long COVID. Researchers do not yet know exactly how prevalent hair loss is among COVID-19 patients, but one study found that among those hospitalized, 22 percent were still dealing with hair loss up to six months later. For those who have not been affected by a COVID infection, the stress and anxiety surrounding the pandemic can be the inciting event for telogen effluvium and hair loss. The protracted length of this stress, now spanning over two years, is also problematic.
The psychosocial impact of hair loss has been shown to be negative for both men and women. One study evaluating over 1,500 men with hair loss found that 70% reported hair to be an important feature of their image. Hair loss was associated with concerns about personal attractiveness, negative effects on social life and feelings of depression. Similarly for women, hair loss manifested in negative self-esteem, self-confidence and psychosocial maladjustment. This impact on mental health has been shown to be present up to 10 years after the initial hair loss was noted.
For most people, telogen effluvium is temporary and reversible with a typical duration of three to six months. Therefore, patience and focus on stress reduction techniques can be successful treatment options. Supplementing a diet with biotin, folate and vitamin B12 is also a consideration. Patients with persistent hair loss may use topical medications such as minoxidil (i.e. Rogaine) and men can use finasteride (i.e. Propecia), though each of these treatments carries risk. In more severe cases or for individuals who have tried medical management without any improvement, hair transplant may be considered. Hair transplant has been shown to improve quality of life metrics, in particular self-esteem and perception of personal attractiveness.
As a result of pandemic-related stress and COVID-19 infections, there has been an increase in hair loss for men and women around the world. While most of these cases are thought to be reversible, mental health should be a top priority in those recovering from this condition. For individuals with persistent hair loss (lasting over six months), we encourage a discussion with your primary care providers, dermatologists and facial plastics surgeons to help determine the best course of action to restore a full head of hair.