Covid-19 Associated Hair Fall

Rzan Abdulhasan Abbas Al-Battat; Oday Taher Mohammed  Al-Hashimi; Raghdaa S. Albanna

doi:10.17605/cajmns.v6i4.2923

Rzan Abdulhasan Abbas Al-Battat Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq https://orcid.org/0000-0002-9679-2203
Oday Taher Mohammed Al-Hashimi Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
Raghdaa S. Albanna Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq https://orcid.org/0009-0008-8936-5554

DOI: https://doi.org/10.17605/cajmns.v6i4.2923

Keywords: COVID-19, Hair Loss, Telogen Effluvium, Alopecia, Post-viral Symptoms

Abstract

The COVID-19 pandemic has introduced a wide array of clinical consequences beyond respiratory symptoms. Among these, hair fall has emerged as a significant post-viral manifestation. A growing number of recovered patients report hair shedding several weeks to months following infection. This paper systematically reviews and analyzes available literature, clinical reports, and observational studies from 2020 to 2024 that explore the link between COVID-19 and hair loss. The most common form is telogen effluvium (TE), triggered by physical stress (fever, infection), psychological trauma, and post-inflammatory cytokine changes. TE typically begins two to three months after infection and persists for up to six months. In some patients, androgenetic alopecia or alopecia areata are also worsened post-COVID. The study also explores the role of nutritional deficiencies, immune dysregulation, and medication side effects. Diagnostic tools such as trichoscopy, blood tests for micronutrient deficiencies, and scalp biopsies are reviewed. Treatments used include topical minoxidil, micronutrient supplements (zinc, vitamin D, biotin), and psychological support. Evidence from 20 peer-reviewed studies is summarized to determine patterns, causes, and best practices for managing this condition. This review aims to support dermatologists in understanding, diagnosing, and managing post-COVID hair fall effectively. It also highlights areas for future research, including long-term prognosis and the efficacy of therapeutic options.

References

F. Fakhar, "The impact of the lack of certain vitamins and minerals intake rate of hair loss in pregnant and breastfeeding women," Clinical Nutrition ESPEN, vol. 61, pp. 293–298, 2024, doi: 10.1016/j.clnesp.2024.05.009.

F. F. Fakhar, "Effect of the deficiency of some essential elements and vitamins on hair fall in pregnant and breastfeeding women," Journal of the Faculty of Medicine of Baghdad, vol. 66, no. 1, pp. 10–16, 2024. [Online]. Available: https://jkmc.uobaghdad.edu.iq/index.php/MEDICAL/article/view/200

A. Nalbandian et al., "Post-acute COVID-19 syndrome," Nature Medicine, vol. 27, no. 4, pp. 601–615, 2021, doi: 10.1038/s41591-021-01283-z.

S. Malkud, "Telogen effluvium: A review," J. Clin. Diagn. Res., vol. 9, no. 9, pp. WE01–WE03, 2015.

R. Sharma et al., "Telogen effluvium in COVID-19 patients: A cross-sectional study," Int. J. Dermatol., vol. 60, no. 10, pp. 1213–1219, 2021.

O. M. Moreno-Arrones et al., "SARS-CoV-2-induced telogen effluvium: A multicentric study," Clin. Exp. Dermatol., vol. 46, no. 8, pp. 1485–1487, 2021.

M. Said et al., "Hair shedding and telogen effluvium after COVID-19: Analysis of 121 cases," Dermatol. Ther., vol. 34, no. 4, 2021.

L. Rudnicka et al., "Alopecia areata in patients after SARS-CoV-2 infection," J. Eur. Acad. Dermatol. Venereol., vol. 35, no. 7, pp. e424–e425, 2021.

C. G. Wambier et al., "Androgenetic alopecia as a risk factor for COVID-19 severity," J. Am. Acad. Dermatol., vol. 83, no. 1, pp. e77–e78, 2020.

J. Shapiro et al., "Post-COVID hair loss: A review of the evidence and guidelines for management," Dermatol. Pract. Concept., vol. 12, no. 3, 2022.

Y. Zhou et al., "Cytokine storm in COVID-19 and its impact on hair follicles," Front. Immunol., vol. 12, 2021.

D. L. Esteban et al., "Mechanisms of post-infectious hair shedding," Int. J. Trichol., vol. 13, no. 1, pp. 34–39, 2021.

A. Goren et al., "Trichoscopy in COVID-19 associated hair loss," Dermatol. Ther., vol. 33, no. 5, 2021.

R. Da Silva et al., "Psychological effects of post-COVID hair loss: A cross-sectional study," Ann. Dermatol., vol. 34, no. 2, 2022.

D. Moher et al., "Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement," Ann. Intern. Med., vol. 151, no. 4, pp. 264–269, 2009.

G. A. Wells et al., "The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses," Ottawa Hospital Research Institute, 2013.

M. Mieczkowska et al., "Telogen effluvium: A consequence of COVID-19 infection," Clin. Exp. Dermatol., vol. 46, no. 1, pp. 202–204, 2021.

A. Czech, T. Satoru Sugihara, and Y. Nishimura, "Characteristics of hair loss after COVID‐19: A systematic scoping review," J. Cosmet. Dermatol., vol. 21, no. 9, pp. 3655–3662, 2022.

S. S. Sattur and I. S. Sattur, "COVID-19 infection: impact on hair," Indian J. Plast. Surg., vol. 54, no. 4, pp. 521–526, 2021.

K. Mieczkowska et al., "Telogen effluvium: a sequela of COVID‐19," Int. J. Dermatol., vol. 60, no. 1, pp. 122–122, 2020.

S. Seyfi et al., "Prevalence of telogen effluvium hair loss in COVID-19 patients and its relationship with disease severity," J. Med. Life, vol. 15, no. 5, pp. 631–636, 2022.

M. G. Yousif et al., "Effect of COVID-19 vaccines on hair loss," Health Educ. Health Promot., vol. 11, no. 3, pp. 1001–1005, 2023.

A. Goren et al., "A preliminary observation: Male pattern hair loss among hospitalized COVID-19 patients in Spain—A potential clue to the role of androgens in COVID-19 severity," J. Cosmet. Dermatol., vol. 19, no. 7, pp. 1545–1547, 2020.

N. Hussain et al., "A systematic review of acute telogen effluvium, a harrowing post‐COVID‐19 manifestation," J. Med. Virol., vol. 94, no. 4, pp. 1391–1401, 2022.

H. Aksoy et al., "COVID‐19 induced telogen effluvium," Dermatol. Ther., vol. 34, no. 6, Art. no. e15175, 2021.