Hair Shedding Surges in Low-Income, Non-White NYC Communities During Pandemic

By Marilynn Larkin

December 30, 2020

NEW YORK (Reuters Health) - The incidence of telogen effluvium (TE), or hair shedding, surged more than 400% among Hispanic/Latinx impacted by the COVID-19 pandemic in New York City, researchers say.

"Due to an initial scarcity of testing, it is unclear if the increase in cases of TE is more closely related to the physiological toll of infection or extreme emotional stress," Dr. Shoshana Marmon of Coney Island Hospital in New York City told Reuters Health by email. "Hair loss is one of the most commonly reported complaints of 'long-haulers' - people with persistent symptoms after infection with COVID-19. It's important that we follow this group in particular, to see if what they are experiencing is in fact TE or something related to ongoing illness or inflammation."

As reported in the Journal of the American Academy of Dermatology, Dr. Marmon and colleagues analyzed medical records of TE patients pre- and post-pandemic.

From November 2019 through February 2020, an average of 7.5 TE cases were identified every two months, corresponding to an incidence of 0.4%. The rate remained stable through June 2020, which saw an incidence of 0.5%.

However, 43 TE patients were identified in July and August 2020, corresponding to an incidence of 2.3%; as Dr. Marmon noted, this is an increase of more than 400%. Most affected individuals (68%) were 31 to 60 years old; 90% were women; and 64% were Hispanic/Latinx (versus 10% White and 2% Black/African American)

The increase was due primarily to TE in persons of color, particularly Hispanic/Latinx, according to the authors, who note that this is "in line with the disproportionately high mortality rate of this subset of the population due to COVID-19 in NYC."

However, no such increase was seen among Blacks/African Americans, who also were severely impacted by COVID-19. Notably, no men had TE in the year prior to the pandemic, whereas five were affected during the pandemic.

Due to reagent shortages at the time, only two TE patients had been tested for COVID-19 (both negative). Therefore, as Dr. Marmon suggests, underlying inflammation may be a factor in this subset of patients.

"Since the virus is so widespread, it is likely there will be upticks in cases of TE in other areas of the US heavily impacted by COVID-19 infection," Dr. Marmon said. "However, the lack of testing and control measures coupled with the population density of New York City resulted in an enormous initial wave of infection and anxiety in the spring that hopefully won't be replicated at this stage of the pandemic."

Dr. Adam Friedman, Interim Chair of Dermatology and Residency Program Director at George Washington School of Medicine and Health Sciences in Washington, DC, told Reuters Health he is seeing increases in TE "and the timing makes plenty of sense, as the onset of shedding is typically three months following the traumatic event (rise of the COVID-19 pandemic, shutdown, mass hysteria circa March 2020)."

"TE progresses typically along a bell curve-like timeline - shedding escalates for roughly several months, subsides, and new hairs replace the old at a rate of 1 cm/month," he said by email. "Some people do get recurrent TE, which can complicate the duration; I typically say it takes roughly a year to feel somewhat baseline."

"The bigger issue is if there are any other conditions that can impact hair- e.g., androgenic alopecia, primary inflammatory scalp disease (which will also worsen with stress), nutritional deficiencies, etc. - that will limit how well the hair returns."

SOURCE: Journal of the American Academy of Dermatology, online December 10, 2020.