Hair Loss in COVID-19 Survivors

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Hair Loss in COVID-19 Survivors: Causes, Symptoms, and Treatment Options

Since the beginning of the COVID-19 pandemic, medical professionals have been closely monitoring the symptoms and long-term effects of the virus on survivors. One of the lesser-known effects of COVID-19 is hair loss, which has been reported in many COVID-19 survivors. In this article, we’ll explore the causes, symptoms, and treatment options for hair loss in COVID-19 survivors.

Causes of Hair Loss in COVID-19 Survivors

Hair loss, also known as alopecia, can occur as a result of several different factors. In the case of COVID-19 survivors, hair loss may be caused by several factors related to the virus and its treatment. Here are some of the potential causes of hair loss in COVID-19 survivors:

  • Stress: COVID-19 is a highly stressful experience, both physically and mentally. The stress of the illness, combined with the anxiety and uncertainty surrounding the pandemic, can lead to hair loss.
  • Inflammation: COVID-19 is known to cause inflammation throughout the body, including the hair follicles. Inflammation can disrupt the normal growth cycle of hair, leading to hair loss.
  • Medications: Some medications used to treat COVID-19, such as steroids, can cause hair loss as a side effect.
  • Nutritional deficiencies: COVID-19 survivors may experience nutritional deficiencies as a result of the virus and its treatment. Nutritional deficiencies can contribute to hair loss.

Symptoms of Hair Loss in COVID-19 Survivors

Hair loss in COVID-19 survivors can present in several different ways. Here are some of the common symptoms:

  • Thinning hair: Many COVID-19 survivors experience thinning hair, particularly in the months following the illness.
  • Patchy hair loss: Some survivors may experience patchy hair loss, where hair falls out in small, round patches.
  • Widespread hair loss: In more severe cases, COVID-19 survivors may experience widespread hair loss across the scalp or even throughout the body.

Treatment Options for Hair Loss in COVID-19 Survivors

Fortunately, hair loss in COVID-19 survivors is often temporary and can be treated. Here are some of the treatment options available:

  • Topical treatments: Topical treatments such as minoxidil (Rogaine) can help to promote hair growth and prevent further hair loss.
  • Nutritional supplements: Nutritional supplements such as biotin and iron can help to improve hair health and promote growth.
  • Steroid injections: In cases where hair loss is more severe, steroid injections into the scalp may be used to reduce inflammation and promote hair growth.
  • Hair transplants: In rare cases where hair loss is extensive and other treatments have been ineffective, hair transplants may be considered.

In addition to these treatments, it’s important for COVID-19 survivors to take steps to manage their stress levels and maintain a healthy diet to support hair health.

A research have confirmed that hair loss is common among COVID-19 survivors and primarily suggest that this symptom may be associated with a derangement of the Gas6/TAM system.

The study findings were published in the peer reviewed International Journal Of Molecular Sciences.
https://www.mdpi.com/1422-0067/24/7/6257
 

While COVID-19 is still a global public health threat, the persistence of symptoms and long-term sequelae in people who recovered from SARS-CoV-2 acute infection is emerging as a relevant health issue worldwide. In this study, we aimed to evaluate the potential implication of the Gas6/TAM system in the pathogenesis of long COVID. Based on our data, this system does not seem to be altered among patients complaining of post-acute COVID symptoms—with a single major exception: hair loss after SARS-CoV-2 infection.

Hair loss is common among COVID-19 survivors. In the present cohort, more than one-quarter of subjects complained of hair loss following COVID-19, which is a figure in line with what was reported in a recent meta-analysis reporting that the prevalence of hair loss in COVID-19 survivors is 25% (CI95%: 17–34%) [39].

The mechanisms underlying this specific complication are unknown. Several risk factors have been suggested as major players, such as the stress induced by a viral infection, the potential involvement of the treatment(s) used during the acute phase, and the psychosocial stress induced by the global pandemic itself [40].

To elaborate, chronic stress seems to impact hair growth by keeping hair follicle stem cells (HFSCs) in a quiescent state due to microenvironment changes with the consequent hair loss [41]. Although the Gas6 gene has been revealed as a candidate gene working as a regulator of hair growth, given the fact that it is stress sensitive, there is currently a paucity of data evaluating the involvement of this system in the development of hair loss.

In a recent paper, Choi et al. demonstrated that corticosterone, which is the rodent equivalent of cortisol in humans, controls HFCS’s quiescence and hair growth in mice via the regulation of Gas6 expression. It is worth noting that the Gas6 protein in normal conditions is able to bind the Axl receptor on HFSCs activating the genes involved in the cell cycle [42].

Under chronic stress conditions, increased corticosterone levels lead to the suppression of the Gas6 expression acting on the dermal papillae. In mice, the forced expression of Gas6 in the dermis is able to overcome this inhibition and promotes hair growth [43]. Therefore, according to these studies, higher levels of Gas6 may protect against hair loss. In line with this hypothesis is that in our study population, the patients complaining of hair loss showed decreased levels of Gas6 and sAxl compared to all others.

Although these findings are interesting, our study has some limitations. First, the population size is relatively small. Second, we did not measure the baseline levels of Gas6 and sTAM to understand whether these biomarkers may also have a pathogenetic role in the development of hair loss.

Lastly, the definition of hair loss was self-reported without a formal hair loss diagnosis. Indeed, to overcome the lack of information about this specific complaint, we administered a retrospective questionnaire. According to this, the majority of patients described diffuse hair loss, and only a minority described patchy hair loss.

In more than 75% of subjects, the symptom was completely resolved over time; although, around a quarter reported persistent hair loss. Regarding patients who recovered, a possible explanation could be telogen effluvium (TE), which is characterized by diffuse hair loss and increased hair shedding after several weeks post-infection. In a recent systemic review and meta-analysis, Nguyen and Tosti described the hair-related manifestations of COVID-19, including telogen effluvium, which is presented as a new-onset sequela of COVID-19 [44]. Moreover, as suggested by Christensen et al., alopecia areata may also be a dermatologic manifestation that arises 1 to 2 months following a contraction of SARS-CoV-2 infection [45].

We reported that the female sex is strongly associated with hair loss, as increased hair shedding is more noticeable in women compared to men. However, our findings strengthen the rationale basis for further studies evaluating the potential involvement of this pleiotropic system in hair loss beyond the setting of the SARS-CoV-2 infection.

We also evaluated the potential association of Gas6 and its soluble receptors with long COVID. This hypothesis was based on the observation that long COVID may be associated with persistent organ damage and lung fibrosis [5]; moreover, according to recent evidence, this condition may be associated with the presence of persistent low-grade inflammation, as disclosed by increased levels of pro-inflammatory cytokines [46]. Gas6 is a central molecule in the regulation of the interplay between inflammation and fibrosis [14]; therefore, it is a candidate biomarker of long COVID with a strong rationale.

The prevalence of persistent complaints was high in our population (39.3%), and this was consistent with the data that we already published on a larger cohort at the same time point, to which this subset of subjects belongs [5]. However, only sAxl levels were marginally decreased in long COVID patients in our population, and this association was lost when considered in the context of a multivariate model.

This seems to rule out a potential role of this system; however, as mentioned above, the baseline levels of Gas6/sTAM should be assessed to definitively rule out a potential role of this system. Indeed, in previous papers, higher plasma Gas6 concentrations upon hospital admission during the acute phase of COVID-19 predicted a more severe evolution [35,36].

Whether this is also associated with an increased risk of long-term sequelae development should be assessed in an ad hoc study. It should be noted, however, that in our cohort the severity of acute disease was not predictive of long COVID development. Lastly, it is also worth noting that Gas6 and sAxl levels one year after hospital discharge remain associated with the class of severity reported in the acute phase of COVID-19, as this was already shown in baseline Gas6 and sAxl levels by other authors [36].

In conclusion, our findings confirm that hair loss is common among COVID-19 survivors and primarily suggest that this symptom may be associated with a derangement of the Gas6/TAM system. Indeed, while the levels of Gas6 and its soluble receptors one year after the acute disease bear no significant association with persistent organic symptoms, lower Gas6 and sAxl are associated with patients with a history of hair loss following COVID-19. A deeper understanding of the possible factors that contribute to hair loss in COVID-19 survivors could provide novel insights about this common condition in the general population, possibly identifying a novel and relevant pathway.

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