Do you have New Onset Hair Loss? Consider Asymptomatic COVID 19 During A COVID Wave.

New Hair loss is a Strong Predictor of Prior COVID19 Infection

Every single day in the last 4 weeks, patients call or email my office telling us their hair is shedding at rates they just don’t feel is normal. Some patients tested positive for COVID 19 recently. Some tested negative with a rapid test. Some never got tested.

After going through the long list of medical issues that cause a person to have increased amounts of shedding (like stress, low iron, thyroid problems, medications, diets), I hear myself saying over and over to my patients “Do you think there is any possibility you had COVID 19 last month?”

At first pass, it seems a bit far fetched. Can a patient who is otherwise healthy, really have had COVID 19 in the past month or two? Well, during a COVID wave, that answer is yes. The reality is it’s not all that far fetched at all. During the peak of a COVID19 wave, new onset hair shedding has a very high chance of representing a telogen effluvium that follows an asymptomatic or symptomatic COVID 19 infection.

A nice study by Estiri and colleagues in 2021 taught use that there are many things that patients might tell us that give us clues that they had prior COVID 19 infection - even if we don’t have rapid tests, and PCR tests.

Estiri and colleagues performed a retrospective cohort study of 96, 025 non hospitalized patients with an RT-PCR test for COVID-19 in a Mass General Brigham (MGB) facility. They detected many de novo phenotypes that appeared in patients at month 3-6 and month 6-9 after a COVID 19 infection

22,475 of the 96, 025 patients (23.41%) were positive for the SARS-CoV-2 virus. Patients reporting hair loss 3-6 months after being tested for COVID 19 were three times more likely to have had a prior COVID positive test result. Hair loss at month 6-9 after a test did not carry any predictive significance.

Other health issues like loss of smell and taste, chest pain, fatigue, shortness of breath, pneumonia and new onset diabetes were also helpful predictor of past infection. However - hair loss was the most helpful predicator overall.

Conclusion

Patients who present with hair shedding during that pandemic may in fact have experienced a symptomatic or asymptomatic COVID 19 infection. A full history is needed to identify the full story of exposures, and contacts and details of testing as well as the symptoms that arose in the days and weeks and months prior to the start of hair loss.

Although hair shedding itself increases the chance that a patient had COVID 19, it is of course not proof by any means. Hair loss together with other new onset symptoms like fatigue, shortness of breath, chest pain, loss of taste and smell increase the chance that the patient’s hair loss is due to prior asymptomatic COVID 19.

A full history, examination is needed in any patient with concerns about hair loss. Blood tests for ferritin, TSH, CBC are mandatory and other tests could be helpful depending on the story.

REFERENCE

Estiri H et al. Evolving Phenotypes of non-hospitalized Patients that Indicate Long Covid. medRxiv. Preprint. 2021 Apr 27