Hair Loss and Long COVID

By Tamsin Zandstra

There is no universally accepted list of Long COVID symptoms; however, according to the American Medical Association, there are more than 200 symptoms that have been associated with Long COVID, one of which is hair loss. 

This article has been informed by interviews with Dr Arash Mostaghimi, Director, Dermatology Inpatient Service, Co-Director, Complex Medical Dermatology Fellowship Program and Assistant Professor, Harvard Medical School and Dr Luis Garza, Assistant Professor of Dermatology, Johns Hopkins Medicine.

COVID-19 may trigger two types of hair loss. The first is telogen effluvium, a scalp disorder defined by non-scarring shedding of hair. The average person will normally lose between 100-150 hairs each day across the entire scalp. A sign of telogen effluvium is when people begin losing more hair than the average amount when brushing the scalp. In addition to limiting the ability to grow hair, the hair is less dense and also less lengthy, which can make hair loss more noticeable. Hair loss is more apparent to individuals than to others and patients are normally the first to notice. 

Telogen effluvium is thought to be caused by a standard response to physiological stress exposure, which interrupts the hair cycle, causing hair loss. The hair cycle has three phases; first, anagen, the growing phase; second, catagen, the regressing phase; and third, telogen, the resting phase. When patients have telogen effluvium, it means that a large portion of hair has switched from the anagen to the telogen phase of the hair cycle, meaning that for 3 to 12 months following this alteration people experience substantial hair shedding and loss. Hair loss peaks between 9 months and 12 months and then most people’s hair begins to return to normal, generally within a two-year period.

Some people may experience a second type of hair loss, chronic telogen effluvium. Telogen effluvium typically begins during acute COVID-19 but may persist for months to years, in which case it may be considered a symptom of Long COVID. Although most telogen effluvium is expected to resolve within 2 years, some people may experience chronic Telogen effluvium through which the hair cycle is permanently shortened.

Among people with hair loss related to Long COVID, roughly 75% are female according to Dr. Arash Mostaghini. Hair loss is often more noticeable in women, due to the loss of longer and often thicker hair which takes longer to be replaced, and the emotional impact may also be greater, so they may be more likely to seek medical assistance for the issue than men. Patients with some pre-existing conditions and inflammatory diseases may be more likely to experience hair loss according to Dr. Arash Mostaghini.

Dr. Arash Mostaghini believes that the best thing people suffering with Long COVID-associated hair loss can do is be patient. People experiencing hair loss often turn to changing their diet, taking supplements, or changing their shampoo; however, this has little impact, and drastic changes can actually lead to more stress, worsening the problem. 

Dr. Arash Mostaghini and Dr. Luis Garza shared that there are some treatments for hair loss such as Anastrozole, Minoxidil and Rogaine that can be taken orally or applied topically. However, it is not entirely clear how well these treatments work for hair loss in general, and for some patients the use of Anastrozole can cause additional shedding or act as a temporary solution, leading to new hair loss when treatment ceases.. For these reasons, such treatments are not advised in all cases. 

If you are experiencing hair loss after COVID-19, or any Long COVID symptoms, it is advised that you speak with your primary care provider before self-diagnosing or treating.