Nearly two years into Diaz’s initial diagnosis of the potentially deadly virus that has to date sickened more than 375 million people and claimed the lives of more than 5.6 million worldwide, she continues to feel the effects of covid-19. A victim of what health experts call “long covid,” the 52-year-old mother of two cleared the virus but still suffers from lingering symptoms. These symptoms include crippling fatigue, migraines, bouts of vertigo and brain fog—a mental state that affects one’s ability to focus, recall information and think clearly. But one of the most egregious symptoms, in fact, is most women’s worst nightmare: hair loss.
“It got on my clothes a lot more,” Diaz recalled of her first brush with hair shedding, medically termed telogen effluvium. “When I got up, there was hair on the pillow case, more than normal. It really started to show after showering.”
Her worst falling out occurred in July 2020.
“There was a tremendous amount of hair coming out. I remember crying—it was that alarming. I don’t want to sound like a shallow person, but it really is scary,” said Diaz, an office manager who has been out on disability since falling ill.
According to Dr. Alexis Young, a dermatologist affiliated with Hackensack University Medical Center, Hackensack, NJ, hair loss is a very common symptom among covid-19 patients. As many as a quarter of those exposed to the virus develop hair loss, although that number could be higher given unreported cases. Hair loss, she said, is reported more by women than men given women’s ability to notice and be affected by it more than men.
Last summer, young saw approximately 10 patients a week for hair loss issues for “a good couple of months.” Now, she sees a handful a month for the same complaint.
“A lot of studies show that in most post-Covid cases, shedding starts two months [after diagnosis] and is consistent with other causes,” explained Young.
Apart from being a side effect of covid-19, telogen effluvium can also arise from major stress on the body. This so-called “shock to the system” can result from major surgery, childbirth, severe psychological stress and malnutrition; it pushes hair roots prematurely into the resting state, or telogen (the third of four phases of hair growth). Typically lasting three months, roughly 10 to 15% of scalp hairs are in the resting phase. These hairs don’t grow or fall out, and new hairs start to form in follicles that have just released hairs during the preceding catagen phase, during which hair follicles shrink and hair growth slows.
Telogen effluvium can be acute or chronic, and precipitated by a stress-inducing event. As many as 70% of scalp hairs may shed eight weeks after the initial trauma. It is normal for people to lose between 50 and 200 hairs a day.
While shedding can persist for up to six months, the prognosis is excellent for most people, Young says. Hairs grow back slowly but surely, taking up to 18 months with hair eventually returning to its natural density.
“I assure patients they won’t go soon from this,” noted Young.
One exception, however, is in covid cases of people who have androgenetic alopecia, or male pattern baldness. In this instance, hair won’t return to full density.
“The biggest complaint I get from patients is seeing a ton [of hair] in the shower drain and bedroom pillows covered in hair,” said Young.
Hair Loss: Getting to the Root Cause and Treatment
The root cause of covid-19 related hair loss is unclear. One possible explanation, says Young, is overactive inflammation that occurs when the body is fighting off infection.
“Cytokines wake up immune cells to fight the infection and those cells can affect hair follicles,” explained Young. “Cytokines cause hair follicles to go into the resting state from the growth state.”
These small proteins are imperative in controlling the growth and activity of other immune system cells and blood cells. Cytokines affect the growth of all blood cells and other cells that aid the inflammatory responses in the body.
Young says data suggests that unvaccinated hospital patients are more likely to develop hair loss as a side effect of the virus than patients with milder cases and people who are fully vaccinated. Infection severity depends upon the amount of inflammation present in the body.
For those in the throes of covid-19-related hair loss, there is no treatment except having a good attitude while the shedding runs its course, Young explained. Through her first six-month shedding period, Diaz treated her fragile hair and scalp like fine china. She wore loose ponytails, avoided the blow dryer and kept her head covered with scarfs until the day finally came when the shedding slowed and her chestnut-colored locks began to sprout back.
“It started to slow down,” she called of her hair loss. “Then, after a couple of months, I saw a tiny regrowth on my forehead and was like, ‘Oh my God!’ I was thrilled.”
For people experiencing hair loss linked to stress, solutions are available. Regenix, for one, is a hair loss solution brand that provides a drug-free, personalized treatment based on a hair analysis. Founder and Chief Executive Officer Bill Edwards is a scalp and hair care specialist with more than 40 years of experience treating clients like Oscar-winning actor Matthew McConaughey.
Edwards says he’s seen an increase in patients with covid-related hair loss in the past two years.
“I’ve seen a huge influx over the past year and helped with people who have hair loss because of the stress associated with covid-19,” said Edwards. “Whether you catch it or not, there are conscious stress levels involving financial circumstances, and it’s having an effect on people’s hair. When the follicles are not getting the nutrition they need to function properly, they go dormant and hair falls out.”
B-complex vitamin supplements, specifically B6 and B12, are essential for cell regeneration, said Edwards. They also help relieve stress, boost cognitive performance and reduce symptoms of anxiety and depression. While foods such as salmon and other seafood are rich in these particular vitamins, it’s not always easy to get the precise dose needed daily. And if impacted sebum and buildup within hair follicles prevent nutrient absorption, supplements can work wonders, he says. Among its supplement offers, Regenix sells B-complex with amino acids formulated for men and women.
Currently, Regenix is expanding its reach with a new at-home product line. The Regenix 3 Stage System is a non-surgical, custom treatment program that helps with hair loss or thinning, in addition to other common skin conditions such as dermatitis, dandruff and psoriasis. The solutions also help repair extremely dry or damaged hair from chemicals and styling products.
The Regenix Starter Kit ($199) is formulated to treat hair thinning and hair loss. The kit comes with a 30-day supply of treatments (12 vials), an assigned hair specialist and a hair microanalysis and report with instructions. Purchasers receive a moisture balance shampoo or pure balance shampoo; deep follicle cleanser; and essential scalp protectant. One vial is to be used three times a week.
Other brands catering to the treatment of hair loss precipitated by the covid-19 pandemic or other stressors include women’s hair care brand Hers. In January, the company launched Topical Finasteride and Minoxidil Spray containing 3% finasteride and 6% minoxidil that work as a spot treatment spray designed specifically for women. The other option that the company offers, called Oral Spironolactone, is an antiandrogen pill clinically proven to slow shedding and regrow new hair.
Also new this month is BosleyMD’s expansion into CVS stores nationwide. BosleyMD’s products, which include women’s and men’s hair growth supplements and hair regrowth treatments with minoxidil, can help prevent hair loss and thinning.
Life After Covid-19-Related Hair Loss
Whatever the cause of hair loss, the best antidote is to maintain a healthy lifestyle and a positive attitude. This can be achieved by understanding one’s stress triggers and making a conscious effort to avoid them.
“Some people don’t even know they are stressed,” said Edwards. “It’s a subconscious thing. You start losing sleep and start drinking more coffee. You don’t feel like having a good lunch so you go to grab a burger at McDonald’s. You’re too tired, so you skip the gym, and the snowball effect takes hold and then it starts affecting your hair.”
Edwards added that making lifestyle changes such as eating less fattening foods, getting more sleep and exercising are a good place to start. In its analysis, Regenix experts look for debris, micropollutants and hair product buildup.
“The elements that will lengthen the growth cycle of hair is a complicated system, it varies greatly from person to person,” explained Edwards, adding that one’s genetics and personal background are taken into consideration when determining the reasons for their hair loss. Stress, he says, is one of the main culprits. He noted that a year ago, Google searches for hair loss were 30% higher than pre-pandemic levels.
While Diaz experienced a second bout of hair loss this past November as a side effect of contracting covid-19, she said it wasn’t as devastating as the first one in summer 2020, and her hair has since returned to its natural density.
Diaz visits the Covid Recovery Center at Hackensack Meridian Health where she is seen by Dr. Jonathan Shammash and nurse practitioner Cristina Martinez. The recovery center provides care for patients experiencing long covid, including symptom management. The Center refers them to specialists such as neurologists and cardiologists.
“The biggest complaints we hear are chronic fatigue and brain fog, heart palpitations and shortness of breath,” said Martinez.
In addition to providing patients with resources for symptom management, the Center is collecting data for a study that can help gain valuable insight into long covid, like who gets it and why. Currently, the center sees about 500 patients – a third of whom are experiencing hair loss.
“There are endless possibilities as to why it happens,” said Martinez of long covid. “We ideally want to treat these individuals and have their lives return to the way they were pre-covid.”
More than managing symptoms, Martinez says the Covid Recovery Center serves as a point of validation for patients.
“Covid is a syndrome. It’s a matter of finding out how we can treat this. In that moment in time, I’ve had patients cry that they felt validated and that they’re not going crazy,” said Martinez.
As for those experiencing covid-related hair loss, Diaz encourages all women to take a page from her book: if she can weather that storm, anyone can.
“I’m the world’s worst person when it comes to being patient,” said Diaz. “It’s kind of hard not to worry when your Roomba doesn’t work because you’ve got so much hair stuck to it. But be patient and give it time.”
And consumers today have more options for treatment from a growing collection of beauty brands offering supplements and topical products.