COVID-19 and Hair Loss Problems

Update: July 2022Systemic review of hair loss after Covid-19.

The biggest news in the hair world for the past eight months has been Covid-19 causing rapid hair loss and shedding. This side effect is especially common in women. My Google Alerts are frequently filled with news on Covid-19 (aka Coronavirus) and hair loss. The latest came yesterday, courtesy of NPR.

Covid Hair Loss Searches
Search interest for “Covid Hair Loss” in Google Trends. Past 12 months.

Does Covid-19 Cause Hair Loss?

According to the official statement from the American Academy of Dermatology:

“Fever is a common symptom of COVID-19. A few months after having a high fever or recovering from an illness, many people see noticeable hair loss.”

This type of rapid and sudden hair shedding is known as telogen effluvium. The unfortunate thing is that the shedding often happens two to three months after Covid-19 (or any fever or illness). And the shedding can last for six to nine months.

It is emotionally draining to see handfuls of hair on the brush and in the shower on a daily basis. Especially if you have never had significant hair loss in the past. Most people who get the Coronavirus do not get tested for it right away (if ever). So oftentimes, one can never make a conclusive diagnosis as to the reason behind one’s sudden and drastic hair loss.

Actress Alyssa Milano was probably the first celebrity to discuss this traumatic post-Covid hair loss issue. In August 2020, she posted a viral video on her hair loss, months after getting infected with Covid-19. Thousand of  women (and some men) have since posted videos on social media showing fistfuls of hair coming out while brushing or combing.

Alyssa Milano Covid-19 Hair Loss
Alyssa Milano Covid-19 Hair Loss. Source: Instagram.

Other Reasons: Stress and Vitamin D Deficiency

It should be noted that telogen effluvium can also be caused by excessive emotional stress. During this past year of the pandemic, global stress levels have skyrocketed. Women with children likely suffered even more. Domestic abuse cases and homicides also went up significantly in the US in 2020. Perhaps the only group that might have experienced reduced stress levels are the highly introverted who enjoy spending significant solo time indoors.

The good thing about stress induced hair loss is that the hair almost always comes back after some months. Unfortunately, it is almost impossible to reduce stress levels when one is shedding hair profusely on a daily basis. Doctors recommend meditation, nature walks and various other relaxation methods to try to stop the vicious cycle. Recovery can be slow, and hair loss treatments such as PRP can only help slightly.

Another lesser discussed issue is Vitamin D deficiency related hair loss. Most people in the developed world spent an unnatural amount of time indoors during this past year of lockdowns. This reduced daily sunlight exposure levels tremendously. Especially in the winter months, when one has a limited window of opportunity to get some direct sunlight.

Expose to the sun’s rays is the only natural way for our skin and body to produce Vitamin D. I take Vitamin D supplements in winter, but still try to make sure that I get direct sunlight exposure for at least a few hours each week. Scientists have even found that low Vitamin D levels increase a person’s chances of dying from the Coronavirus.

Excessively low vitamin D levels weaken our immune system and cause a host of other health issues in the long run. A 2020 study from India found that 86 percent of men with androgenetic alopecia had low serum vitamin D levels. For those with darker skin, it is even more difficult to get appropriate levels of vitamin D from sunlight.

Nanofat and Adipose Tissue Hair Growth

I have written numerous posts in relation to fat cells (adipose tissue) and hair growth. There is clear evidence that adipose-derived stem cells (ADSC) on the scalp impact hair growth. The latest trend at hair clinics entails combination nanofat and platelet-rich plasma (PRP) hair growth treatments. Note that instead of nanofat, some also use the term microfat transfer or grafting.

Update: October 2021 — Emerging role of dermal white adipose tissue in modulating hair follicle development during aging.

Nanofat Injections for Hair Growth

Nanofat Injection Hair Growth
Nanofat for Hair Growth.

During several of last year’s hair loss conferences, a number of presentations entailed nanofat injections into the scalp. Some use the term Autologous Lipocyte Micronized Injection (ALMI) for this procedure.

Most of these fat and adipose-derived stem cell related topics are classified under “stem cell” treatments for hair loss. Note that adipose-derived stem cells (ADSCs) are mesenchymal stem cells (MSCs)

Nanofat injections have been used for many years when it comes to regenerative medicine applications. Usage in hair loss sufferers is more recent. A 2020 study from China found human-derived concentrated nanofat promoted hair growth in mice. The mechanism of action entails activation of dermal papilla cells via the Wnt/β-catenin pathway. Also of interest, a clinical trial from China that tested nanofat grafting for treating androgenetic alopecia ended last year. I am guessing that the results will be published this year.

Perhaps the first study to find benefits from nanofat in male pattern hair loss sufferers came from Italy in 2017. These gains in hair growth lasted even 12 months after initial treatment. The fat was obtained via liposuction using the Tulip Nano device. Also from Italy, Dr. Piero Tesauro is a leading practitioner of nanofat transplantation.

In the US, doctors are increasingly offering combination treatments that include PRP and nanofat. According to Dr. Cheryl Karcher:

“When nanofat is used for hair restoration, she injects it first. She then injects the patient’s PRP on top of it to act as a fertilizer for the nanofat.”

However, in the same article, Dr. Robert Singer warns that there is as yet no safety or efficacy data surrounding nano-fat treatment for hair growth. It should be noted that the somewhat related SVF/Kerastem treatment has shown promising results.

Dermal Adipose Tissue Promotes Hair Growth and Pigmentation

Also of interest, a January 2021 study found that dermal adipose tissue secretes hepatocyte growth factor (HGF). This in turn promotes both human hair growth and hair pigmentation. Among the co-authors of this paper include Dr. Ralf Paus (see Monasterium) and Dr. Maksim Plikus (see Plikus Lab).

What was especially interesting to me in this new 2021 paper was a link to a 2019 paper. Apparently, autologous fat grafting to the face can in rare instances lead to unwanted hair growth (hirsutism). Further evidence of the connection between adipose cells and hair cells.

Fat Grafting Hair Growth
Hirsutism from facial autologous fat grafting. Source: Karger.