Hair Loss after COVID 19: Large Study Provides Valuable Clues

Brazilian Study Puts Hair Loss at the Top of the List of Post COVID Issues

A study from Brazil set out to evaluate the prevalence of hair loss, trichodynia (hair pain), and other clinical complaints within 3  months following COVID-19 infection. An electronic survey (questionnaire) was used to collect data on a variety of parameters.

Participants had variable degrees of illness. 89 .4 % of participants were treated at home and 6.7 % were treated in hospital and 3.9 % were treated in the ICU. Most patients (86 %) had at least one post COVID issue int he first three months after the COVID infection ended.

Hair Concerns in Post COVID Patients.

About 50 % of patients had hair loss after COVID 19 and this was fairly equally divided between mild hair loss (14-16%), moderate hair loss (14-16%) and severe hair loss. (17-19%). Patients who were hospitalized were more likely to have severe hair loss.

Hair loss was associated with disease length and inflammatory symptoms such as high fever, severe dyspnea, and myalgia. In this particular study, most patients experienced the start of hair loss within the first 30 days of infection. In fact, hair loss started within 30 days after the acute COVID-19 symptoms in 2,156 (77%) patients and between 30 and 60 days after such symptoms in 421 (15%) patients.

Female patients were more likely affected than male patients. Moderate or severe hair loss followed COVID-19 infection in 1,761 (44%) women and in 163 (9%) men

Trichodynia following COVID19 Infection

Trichodynia (scalp and hair pain) was found in about one quarter of patients (22-24%). 10-12 % experienced the onset of trichodynia during COVID 19 and 11-13 % experienced it after the infection had resolved. Patients with late onset trichodynia were more likely to have had severe disease and been hospitalized (17 % vs 11 %, p<0.001). Trichodynia was more common in patients with hair loss, weakness, paresethesias and memory loss. Specifically, patients with hair loss were six times more likely to have trichodynia (OR 6.1). Patients with weakness were 1.8 times more likely to have trichodynia. Patients with paresethesias were 1.5 times more likely to have trichodynia and patients with memory loss were 1.4 times more likely to have trichodynia.

Other Symptoms in COVID 19 Patients

In this study, hair loss was the most common symptom. Other symptoms were less common but included memory loss (38-41%), loss of attention (35-37%), weakness (32-34%), anxiety (29-32%), headaches (27-30%), and depression (24-25%). Other issues included arthralgias (18-20%), dizziness (18-20%), cough (17-19%), chest pain (12-13%, and limb paresethesisas (12-14%).

Comments

This is an interesting study. First, it’s large size is interesting as this add some value to the study. COVID hair loss occurred in 50 % of patients in this study which is higher than some other studies which suggested a number closer to 20%. The authors point out that hair loss in other viral diseases like dengue occur in around 20 % so if this data is representative of the real world, it puts Sars-COV2 at the top of the list of viruses that cause shedding.

Shedding in this study occurred quite quickly after infection. 77% of patients started shedding within 30 days. This too is higher than other studies of COVID 19 hair loss which suggested a mean of 8 weeks (56 days). Nevertheless, it shows us that the mechanisms governing TE may not be the classic mechanisms we’re all used to (namely shedding 2-3 months post infection).

We need to be aware of the trichodynia in patients. This can be quite disabling and add to the burden of illness that post COVID syndrome creates. How best to treat this is not clear but likely efforts to stop shedding will be helpful.

Listen to the Article on Dr. Donovan’s Evidence Based Hair Podcast

REFERENCE

Muller-Ramos P et al. Post-COVID-19 hair loss: prevalence and associated factors among 5,891 patients. Int J Dermatol 2022 Jan 26.