Hair loss can be panic-inducing, but it doesn’t need to be permanent.
Aside from all the obvious ways the pandemic changed our daily life (too many to name, frankly), there was one less-pressing but still pretty distressing one that plenty of us noticed: more hair loss. As Covid-19 hit — and lingered — so many people realized they were seeing more hair in their shower drains. Was it stress? Covid? A natural part of aging? Or something else? To get answers, Katie spoke with Jeff Donovan, MD, a world-renowned expert on the subject.
Watch their interview here:
And for the full conversation, read on! And then, head over to our breakdown of the best hair loss treatment options.
It seems like lot of dermatologists don’t specialize in hair loss — is that correct?
It’s true: We need to train a lot more dermatologists to focus on this area. There are so many areas of the skin to focus on, but we really haven’t done a good enough job getting enough people to specialize in this field. But there’s a desperate need and hair loss is an issue that’s devastating to so many people.
People who experience this know how psychologically devastating it can be, especially when women start to lose their hair.
Hair loss has a big impact on the way people feel. Hair is a part of our self-identity. It’s a part of part of who we are. It certainly affects women to a greater extent than men. And it absolutely impacts so many aspects of a person’s life: Their social life, their family, the way they feel, and even the way they carry themselves. A lot of people don’t appreciate just how much it impacts you, until it impacts them.
I know you’re seeing the number of people who are losing their hair skyrocketing recently. Can you tell us about that?
The Covid pandemic has really impacted hair loss. Anywhere from 25% to even 50% of people that have had Covid-19 experience some degree of hair loss. And so when you add up all the numbers of people around the world that have experienced Covid-19, those hair-loss numbers are astronomical. One kind usually starts a month to two months after a person has recovered. So right when a person feels like the worst is over, now they’re seeing hair in the brush, and hair in the drain.
There’s non-scarring and scarring hair loss: What is non-scarring hair loss?
There are a lot of different types of non-scarring hair loss. And essentially what it means is there’s a good ability for the hair to come back. That hair follicle is not scarred over — the follicle is open and it’s ready to produce a hair. So male-pattern balding is an example of non-scarring hair loss, female-pattern hair loss is an example of non-scarring. The hair loss from Covid is an example of non-scarring. The chance is there for the hair to come back. Now, sometimes it’s hard to get the hair back. But we know from research that absolutely that potential is there. Somewhere down the road, we’re gonna be able to get hair back in a dramatic way.
For non-scarring, we also have male- and female-pattern hair loss, which are hereditary types of hair loss. We have alopecia areata, which is an autoimmune condition that affects about 2% of the world. We have hair shedding disorders, which is a really large topic and can be influenced by triggers like Covid, low-iron and thyroid problems, and medications which cause hair shedding. Then there are a few other conditions in that group, like trichotillomania, which is hair loss from pulling during certain psychological distressed states. Then there are fungal infections.
Let’s talk about Covid. Do we know what it does to your body that stops hair growth temporarily?
We don’t know all the reasons, but we’ve certainly drawn upon other infections — influenza, dengue virus, all these other viral infections that we’ve studied hair loss in — to get some understanding of what happens in Covid. When one gets an infection, there’s an inflammatory response in the body which causes the hair to want to shed. And we often think of it as a survival mechanism. So when someone has an infection, the body says, Wait a second, I think I’m going to protect the heart, the kidneys, the lungs, the bowels, and I’m not gonna focus as much on the hair right now. I’m gonna let it shed. I’m gonna bring it back six months, nine months later. But right now I wanna devote all my resources to making sure the body is fully protected. And so the hair sheds.
How can you tell if you’re just going through average hair shedding or if you really have a problem?
I always say to my patients that you know your hair the best. So if you usually you get 26 hairs in your brush or in the drain, and now suddenly you’re seeing way more than that, that’s a problem. People are often very focused on numbers. They they’ve come to learn that 100 hairs or more shedding per day is abnormal, and a hundred or less is within the realm of normal. But that’s just a rough guide. The reality is that for some people, 20 to 25 hairs a day is pretty normal for them. And so if they go up to shedding 50 or 60 hairs a day, that’s abnormal.
What about hormonal changes after menopause? Is some of this just the result of hormonal changes and the aging process?
Certainly that’s one of the reasons for female pattern hair loss, or the hereditary form of hair loss in women. It certainly increases dramatically after menopause. Before menopause, it might affect 10% to 15% of women. After menopause, that starts rising to 35% or 40% of women. And so those hormonal changes really are important, especially the decline in estrogen, and the slight imbalance of male hormones or testosterone. So those imbalances after menopause really impact the hair.
Tell us about scarring hair loss.
So scarring hair loss, called scarring alopecia, is often autoimmune in nature. It’s a phenomenon where the hair follicle is being plugged by a scar or scar tissue. So there is scar tissue forming around the hair and that scar tissue gets thicker and thicker, almost like a blanket, and that chokes off the hair follicle. And in the year 2022, scar tissue in the human body is generally permanent. If you get a scar on the arm, it’s permanent. If you get a scar in a hair follicle, it’s permanent. We don’t know how to reverse it, but what we do know how to do in a good number of cases is freeze it in its tracks, so it doesn’t get worse. That’s why early detection is really important. So you can really try to prevent more hair from being lost. It’s interesting, because the scarring happens underneath the scalp and it basically prevents the follicle from growing hair, which it can do in non-scarring cases.
So you have to be kind of alert, because with scarring alopecia, if you wait too long, it’s hard to maintain the hair that you have and prevent more hair loss from occurring, right?
Absolutely. And these scarring hair loss conditions are certainly less common than some of the non-scarring ones, but the rates at which they’re increasing is enormous. Frontal fibrosing alopecia is described as an epidemic, and the rates of this condition are just dramatically increasing. This condition was unheard of 20 years ago, and now it’s a condition that almost every dermatologist sees by the week or month.
Why are these cases rising so much?
It seems that there’s some type of environmental trigger. It may be that some people have a genetic susceptibility the day they’re born, but they have to come into contact with some kind of environmental trigger. And the race is on to figure out the trigger. For a few years, scientists had thought, Gee, maybe it’s sunscreens. And then that’s kind of fallen out of favor a bit. But we realized that a lot of these chemicals in the environment are hormonal manipulators or what we call endocrine disruptors. So researchers are really trying to figure out what is it that’s activating the immune system. Is it allergens? Is it certain chemicals? But we think it’s something in the environment that people are coming into contact with that’s triggering the immune system.
We got a lot of questions about biotin — people want to know if it’s a good hair loss treatment.
You know, we do not have good evidence that biotin is all that helpful for the hair. I absolutely know that comes as a surprise to so many people, because we’ve heard about it for so long. But the reality is, for the vast majority of people, taking a biotin supplement shouldn’t have a dramatic effect on the hair. It’s not difficult to get biotin in most diets, so there is no good evidence that biotin is helpful for most people. Now in pregnancy and certain nutritional issues, or patients undergoing chemotherapy, patients on certain drugs, or the elderly, there may be a role for biotin in those states. But not for most people.
Is hair loss seasonal? Is it related to the thyroid? Should you start using Rogaine? Do hair-growth shampoos actually work? And can you cure hair loss with the right diet? We’ll get to those questions in our next article with Dr. Donovan. Stay tuned to Wake-Up Call for more!
