It’s almost Summer of 2021. It’s been a crazy year. You survived COVID. You’ve had your vaccine. You’re ready to rejoin society for a glorious summer. But wait! Now, you’re losing your hair.
This has been the plight of many patients in my office lately.. To be honest, I’m losing a lot of hair myself. What is going on? What can you do?
Most hair loss post-COVID is a telogen effluvium. Telogen effluvium is a type of hair loss that usually occurs after an illness or major stressor. Our previous posts have addressed Telogen Effluvium in more detail. But let’s review it here as well.
What is a Telogen Effluvium? Telogen Effluvium is a common type of hair loss or alopecia where hairs stop cycling and growing in a normal way. All hairs on the body generally go through three stages: Anagen, catagen, and telogen. Anagen is the active growing stage. Catagen is the transition stage. Telogen is the resting phase. Every day, about 100 hairs shift into the resting phase, 100 hairs fall out, and 100 others kick back into the active growing phase. This is the normal hair cycle. Most types of hair loss are a problem with the telogen or resting phase.
Why Does This Occur?
Scientifically, telogen effluvium occurs when too many hairs are in the resting or telogen phase. Hairs shift into the telogen phase and eventually fall out. In the normal hair cycle, telogen hairs naturally kick back into the actively growing anagen phase and start growing again. “Thinning” and loss of hair is noticeable when an excess number of hairs remain in the telogen phase and don’t start actively growing again. This can occur for many reasons including stress, medical problems, medications, and more. We’ve had a least a little of that in the past year. In many current cases, the stress of COVID on the body is causing the telogen effluvium.
To simplify things, we will break telogen effluvium into two main types – Acute and Chronic. This short post cannot possibly address everything known about telogen effluvium. However, it will address most of what I discuss in the office about telogen effluvium each day.
Acute Telogen Effluvium
Acute telogen effluvium occurs after a single event. In the case of COVID, following illness, an excessive number of hairs shift into the telogen or resting phase. This usually is noticed 2 to 3 months after the inciting event, when all the hairs in the telogen phase start falling out as new anagen actively growing hairs replace and push them out. Telogen effluvium can cause the loss of thousands of hairs in a short period of time. This is quite alarming to patients. However, acute telogen effluvium is usually a single event. Hair follicles often naturally recover. As hairs regrow, there is a collection of short stubbly hairs at the part and the frontal hairline. Recovery takes time as hairs grow about a centimeter a month. It can take a year or more to get hair looking normal again.
Chronic Telogen Effluvium
COVID has been a truly unique illness. The physical effects are both short-term AND long-term. Chronic telogen effluvium occurs when an ongoing problem causes hairs to repeatedly and continually shift and STAY in the telogen or resting phase in excessive numbers for more than six months. In chronic telogen effluvium, the challenge is to identify the cause and eliminate it. Usually, it is difficult to identify what triggered this condition. However, with COVID it is much easier to nail down.
Most of the patients I have seen in the office are 3-6 months out from having COVID when they start noticing their hair loss. My own hair loss started about 3 months post COVID, but it took awhile for me to really accept that I needed to do something about it. For those of us with post-COVID telogen effluvium, it is likely both acute and chronic telogen effluvium.
How to Treat Hairloss Post COVID
Unlike acute telogen effluvium, in chronic telogen, effluvium hair follicles are less likely to recover spontaneously, even once the inciting problem is resolved.
Minoxidil (Rogaine)
Minoxidil was originally designed as a blood pressure pill. Those who took the pill grew excessive hair. It was another of those accidental discoveries. FDA approved Rogaine in 1988 as safe to use by men and women. There is no hormonal effect. There traditionally have been two or more formulations, labeled “men” and “women.” Differences in these products are differences in concentration and inactive ingredients, not differences in the active ingredient, minoxidil. Tips on buying and using Rogaine:
1-Get the 5% independent of labeling as “men” or “women.”.
2-Get the name brand. You want it to work, and applying it is a lot of work. Splurge.
3-Apply to the areas of hair loss ONLY as directed EVERY DAY for six months. In my experience, patients who stick with the regimen have an excellent chance of growing hair. Traditionally Rogaine was used twice a day, there are new once a day extended release versions.
4-The diagram that comes in the Rogaine package is to comply with FDA standards because Rogaine was FDA approved for male patterned loss. Applying Rogaine to the entire area of hair loss is okay.
5-Some temporary hair loss will be seen in the first month or so of use because the new ANAGEN active growing hairs are pushing the old resting hairs out of the hair follicles.
Rogaine is my number one recommendation by far for post-COVID or any other kind of telogen effluvium. Rogaine works to kick the hairs into the active growing anagen stage and HOLD THEM THERE. Rogaine must be used EVERY DAY to effectively hold the hairs in the active growing phase. Rogaine can continually be used to encourage anagen growth until hair is back to its normal appearance. Realistically, that will take at least 6 months. Once hair density appears normal, decrease to every other day and taper off Rogaine over a few months. If significant hair loss recurs after Rogaine’s use is ceased then resume Rogaine. As hairs regrow, there is a collection of short stubbly hairs at the part and the frontal hairline. Recovery takes time as hairs grow about a centimeter a month. Many patients are afraid or don’t want to commit to using Rogaine, but it is the most effective treatment at getting the hairs jumpstarted.
Biotin
Biotin is the B7 vitamin that is most recommended for hair and nail growth. It is available over the counter in hundreds of products. The Recommended Daily Allowance (RDA) for biotin is 30mcg. Most multivitamins do not contain the RDA, so often a separate biotin or “hair and nail” supplement may be helpful. Biotin is a water-soluble vitamin, so any excess is excreted in the urine, and super-high doses of biotin essentially make expensive bright yellow pee. Despite its widespread use and recommendation, there is little actual scientific evidence that biotin is effective outside of true biotin deficiency which is rare. It is, however, safe and inexpensive, and anecdotally effective, so I take an “it won’t hurt” position. Because biotin “strengthens” hair it will take at least six months to see a noticeable change in the hair. It is important to note that biotin WILL NOT affect the hair cycle like Rogaine.
Hang in there! It will get better. One of my instructors in residency told us to always tell women, “You’re not going to go bald, don’t worry!” So don’t worry, use your Rogaine, and this too shall pass! Check out some of our previous posts about hair loss.
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