Aug 28, 2020

Commentary: Stress-related hair loss on the rise this COVID-19 outbreak

The pandemic of stress may potentially be leading us to lose hair – and curing the root of this will involve more than scalp treatments or a better shampoo, says the National University Hospital’s Dr Chris Tan Lixian.

SINGAPORE: Jane*, a stay-home mum to two school-going kids, came to see me at my clinic recently complaining of increasing hair loss since the start of the circuit breaker period.

She said she was shedding in excess of 200 strands of hair a day.

She had been feeling stressed during that period where she had to care for her children, parents and tend to household chores while being cooped up at home. She felt fine otherwise, not exhibiting any symptoms of illness.

THE HIDDEN VICTIMS OF COVID-19

Stories like Jane’s complaining of more hair loss since COVID-19 morphed into a pandemic have been more commonplace in Singapore. 

Women more than men tend to seek medical attention for hair loss in our experience, perhaps because they are more conscious about the impact to their physical appearance.

The Cleveland Clinic, one of the top hospitals in the US, has similarly reported seeing more patients for stress-related hair loss.

This pandemic has impacted the lives of many people all over the world, economically, physically and mentally. You could be a victim of the infection, a breadwinner who lost your job or just the average Joe forced to stay home due to lockdown measures.

But even people who have managed not to catch the infection so far have had their lives disrupted in unimaginable ways.

The mental stress associated with the socioeconomic fall-out and stringent public health measures, coupled with the challenge of getting through each day, can cause hair loss.

Doctors around the world are reporting a rise in stress-related hair loss. Chronic stress might be at the heart of these conditions.

Sungkyunkwan University School of Medicine in Seoul did a study involving 13,000 men showed that men who worked more than 52 hours a week lost twice as much hair as men who worked less than 40 hours a week.

WHY DOES INCREASED HAIR LOSS HAPPEN?

Telogen Effluvium is the most common form of hair loss. The hairs on our scalp go through a normal cycle of growth, rest and then shedding.

When one suffers from an acute or chronic illness, this cycle is disrupted and more hairs are shunted into the shedding phase, resulting in increased hair loss.

The same occurs when a person is stressed. Telogen effluvium can also be caused by certain medications, major surgery, nutritional deficiencies, child birth and major organ dysfunction such as the kidney or liver.

Alopecia Areata, an autoimmune condition where the body’s own immune cells damage the hair cells, causing them to fall off, is another culprit of hair loss.

The hair fall can be diffusely over the entire scalp, or more commonly over a localized area, giving rise to a focal bald patch. An acute illness or stress can be the trigger that causes this immune mediated self-damage of our hair.

We often tend to think of older adults who may suffer from these afflictions but even youths may not be spared.

Another patient I met was a teenager, Sarah, who was brought by her mother for enlarging bald patches on her scalp. Her mother said that her daughter could not concentrate during her home-based school lessons and was struggling with her homework.

She had started pulling at her hair and these actions got more frequent and excessive the more stressed she was, resulting in these enlarging bald patches.

Trichotillomania, the condition Sarah has, is a third and least common form of hair loss where people start pulling out their hair as a stress response. People react and respond to stress in different ways. Some people listen to music to relieve stress. Some people binge eat, while others participate in exercise.

The cause is often an underlying psychological disorder or stress. The individual develops an irresistible compulsion to pull hair from their scalp.

These patients often present with irregular bald patches on the scalp and broken hair strands of varying lengths.

HOW MUCH IS TOO MUCH HAIR LOSS?

Someone affected indirectly by COVID-19 may experience hair loss. Hair fall in excess of 80 to 100 strands a day is considered abnormal.

There are obviously many other causes of hair loss. Hair loss can be rapid or gradual, focal or diffuse. Fortunately, in the three types of cases above, the hair loss is often self-limiting once the initial illness or stress is over, and the hair usually grows back.

People tend to underestimate the impact of hair loss and forget the change in physical appearance can be a blow to one’s self esteem, especially if it happens rapidly. An unwanted vicious cycle may occur when the stress of dealing with hair loss aggravates the situation.

People often think hair loss can be attributed to high MSG intake but in my experience, it’s not a specific diet, but an imbalanced diet lacking in nutrients important for healthy hair, including iron, zinc and vitamin D.

Extreme situations such as those seen in patients with anorexia nervosa, resulting in rapid and drastic loss in weight, is also a shock to the body that can lead to hair loss, often compounded by nutritional deficiencies as a result of extreme dieting habits.

This pandemic does not seem to be one that will pass soon. We will likely see more cases of people suffering from hair loss, related to COVID-19 or not.

GET HELP

What can you do if you are suffering from hair loss during this period?

My advice is to consult a healthcare professional, such as a dermatologist, who is trained to manage hair loss.

The doctor would ask more questions during the consult to see if further investigations, including blood tests and a scalp biopsy, may be required to uncover any scalp disorders. 

A scalp biopsy is the sampling of scalp tissue via a scalpel. This is done under local anesthesia and the wound is stitched up, leaving you with a small scar.

The doctor would then recommend various treatments depending on the most likely cause. People should note that treatment responses, including those involving lotions, oral supplements or steroid injections for autoimmune conditions, will take time, even these are successful, as hair takes time to regrow.

Sarah has since gone back to school and now enjoys her time with her friends. She is coping better with lessons and her school work.

Her mother has noticed that she no longer pulls at her hair and new hair has regrown. 

Jane has also seen a reduction in the rate of her hair fall after her stress levels came down when the circuit breaker measures were lifted.

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*Pseudonyms were used for this commentary.

Dr Chris Tan Lixian is a Consultant in the Division of Dermatology, Department of Medicine, at the National University Hospital.

 

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