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Hair fall during the Covid era

More than a year into the pandemic and we have learnt to expect the unexpected and are still uncovering different ways the SARS-COV2 virus is affecting the humans. We are now in the third week of January and weathering the ‘third wave’ after most of us have spent months being stuck at home due to the pandemic. We are now faced with this increasingly transmissible variant of the virus. Just when we thought cases were receding and hoping to restart our lives this wave has come upon us. However, the silver lining to this cloud was that this virus though more infective is causing mostly mild disease.

We are doctors dealing primarily with hair loss management and hair restoration, have seen a significant increase in complaints of hair fall in the last 20 odd months.

During the earlier part of the pandemic being cooped up at home had left many people isolated and scared about what the future might bring. People from different walks of life have experienced this totally new way of life. They were living with the stress caused by the fear of contracting the illness, losing of jobs, financial issues, and in general what the future holds for them. Most people in the metros in India learnt to manage without house helps and juggle the work from home scenario with managing the domestic duties.

Since April 2020 we have been getting an increasing number complaints of hair fall from our patients both existing and new. Not only were they seeing a lot of hair fall while shampooing or towelling their hair, but also on the floor when they cleant the house (since they are responsible for mopping the floors of their houses with house helps not coming).  This complaint was not restricted to those who were already battling hair loss issues but to others who did not have any hair fall issues.

From an evolutionary perspective hair growth is a unique mammalian trait which serves many important functions like thermal insulation, camouflage, social and sexual communication, also protects from the elements, etc. This protein containing fibre is a by-product of the hair follicle. We have close to five million hair follicles on our body and about 100,000 of these on the head.

The hair follicle is a miniature organ which undergoes controlled growth and death periodically and ends up producing hair. It is fair to say humans have roughly 90,000 to 100,000 hair follicles on the scalp. With evolution most of the hair on the human body has miniaturized to fine hair leaving the thicker terminal primarily on the scalp and eyebrows and the face and body of post pubertal men and axillae and pubic regions of both.

To produce new hairs, existing follicles undergo cycles of growth (anagen) producing an entire hair shaft from tip to root, regression/involution (catagen) and rest (telogen) where the follicles reset and prepare their stem cells so that they can receive the signal to start the next growth phase and make the new hair shaft. The follicle in resting phase will graduate to the next phase called the exogen – the phase of the cycle wherein the signals for shaft release are given and the processes for that release are initiated and successfully executed which ends with shedding of the hair shaft. At any given time, the number of hair follicles in three stages of growth and shedding: anagen – (80–90%), catagen – 1–5 %, and telogen – 10–20%. If we were to extrapolate the figures, we could see that 10% of hair in the rest phase would amount to about 10,000 follicles. These 10,000 follicles would shed their hair shafts over a period of time which may extend a few months. But, when there is stress in the in follicular environment either due to disease or psycho-emotional stress, some follicles enter prematurely into the resting phase which changes the anagen -telogen ratio predisposing to increased hair shedding after the stressful episode. This is the basis for temporary shedding of hair called telogen effluvium.

Hair fall (telogen effluvium (TE)) after bacterial or viral or protozoal infections is not a new phenomenon and was also reported after the 1918 influenza epidemic. Literature review in terms of the impact of COVID-19 infection on the hair follicle reveals hair loss caused during and post recovery, majorly manifesting as telogen effluvium (TE).

Though cosmetic in nature this complaint of hair fall may have some organic basis. Dr Sandeep and Indu Sattur have tried to address these concerns and explain the possible causes and remedies in their recently published article – COVID-19 Infection: Impact on Hair in the special ‘Hair’ issue of Indian Journal of Plastic Surgery. You can access it from the following link –  https://www.hairrevive.com/publications/.

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