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Covid-19 fatality is not only limited to lungs and heart-related manifestations, but also many other signs and symptoms that appear as a post-complication of the condition in recovered or recovering COVID-19 patients. One among the complications includes hair shedding.
Recently, a famous Canadian rapper, songwriter and singer Aubrey Drake Graham said in an interview that he had experienced hair shedding post-COVID-19. According to a Fortis Hospital blog, many dermatologists have also reported noticing temporary hair loss in COVID-19 patients, months after their recovery from the illness.
A study published in the journal Public Health Emergency COVID-19 Initiative has shown reports of 10 confirmed COVID-19 patients who have experienced increased hair fall within weeks to months after the infection with no history of hair loss. 
In this article, we will discuss the association between hair shedding and COVID-19. Take a look.
What Is Hair Shedding?
The medical term for hair shedding is telogen effluvium and it is a temporary condition characterised by sudden hair fall along with thinning of hair along the frontal hairline.
According to the American Academy of Dermatologists, hair shedding is a common condition as it is normal to lose around 50-100 strands of hair every day, without facing any appearance problems. The condition gets worse when people start losing hair in patches in a shorter period of time with no or less signs of hair growth, causing them temporary baldness which is visible and affecting their appearance and confidence. 
Patients with telogen effluvium often don't have a history of hair loss and the condition usually appears due to factors like chronic stress, improper diet, radiation, heat or illness that has caused weakening of the immune system.
Experts say that people often confuse hair shedding with hair loss, however, both have different characteristics and causes.
In hair shedding, the hair usually grows back to normal on its own or when the underlying condition causing it is treated, while in hair loss, the damage is permanent.
In the prior, though the hair fall is noticeable for some time (around 3-6-9 months), they start growing normally as the hair growth lifecycle returns and they start looking normal again. In the latter, the hair is lost in a defined pattern mainly caused due to genetics, age or thyroid problems.
Possible Causes Of Hair Shedding Due To COVID-19
A study has shown that the COVID-19 pandemic has worsened the psychological state of an individual and has increased psychosocial stress, thus causing then ‘stress-sensitive' hair and scalp diseases, including telogen effluvium.  Also, the condition was higher in female patients before and during the pandemic.
2. Pre-existing hair shedding with stress
Another study says that telogen effluvium was reported in patients who have recovered from severe COVID-19 illness and had pre-existing hair shedding problems. The condition in them has got severe due to the stress of the lockdown. 
3. High dose medications and stress
A study talks about ten patients with identified telogen effluvium related to COVID-19. It says that 80 per cent of these patients were treated with medications like hydroxychloroquine, antibiotics like azithromycin and systemic corticosteroids, which could have triggered hair shedding in them along with psychological and physiological stress surrounding the infection. 
4. In children due to MIS-C
A study reports two pediatric children who have experienced different hair fall patterns due to COVID-related multisystem inflammatory syndrome (MIS-C). The MIS-C is not a disease but is a group of symptoms that involves inflammation of various organs and tissues, including the scalp, thus resulting in hair shedding. 
5. Due to vitamin B12 and other micronutrients deficiency
A study reports of a 38-year-old woman who was diagnosed with acute telogen effluvium due to the deficiency of vitamin B12 and other micronutrients, along with thyroid dysfunction and autoimmunity. She has experienced oily scalp and painful sensation in the scalp, followed by diffuse hair loss in the entire scalp. The diagnosis has shown scalp inflammation, dandruff, dilation of the capillary blood vessels and increased telogen hairs. 
6. Androgen-related hair fall
A study reports of hair fall among male hospitalised COVID-19 patients, doubting the role of androgens in triggering the condition. Androgens are high in males and crucial for their reproduction and sexual function. The infection might have disturbed their androgen levels and have caused them hair shedding. 
Treatment And Management Of Hair Shedding
A study says that there is no specific treatment method available for telogen effluvium. The best way in which telogen effluvium can be managed is by educating patients about the natural history of hair shedding. 
Some of the treatment methods include:
- Medical hair spray: Some patients with severe telogen effluvium are treated with topical 5% minoxidil, mixed with halcinonide solution, and sprayed evenly all over the hair areas where there is a hair loss, once or twice a day.
- Medical shampoos: Washing with shampoos containing selenium sulfide, 2-3 times a week. 
- Nutrients: Consumption of vital nutrients and micronutrients such as folic acid, vitamin A, fatty acids, vitamin D, zinc, selenium, niacin and amino acids that helps in the growth and maintenance of hair. 
- Lowering stress: In many cases, stress is considered the primary cause of hair shedding. Therefore, perform certain mindfulness exercises or yoga to reduce stress and calm the mind amidst the growing tension of the pandemic.
- Medications: It includes prescribed medications like Minoxidil that helps open the potassium channels and widens the blood vessels, thus increasing the supply of oxygen, blood and nutrients to hair follicles and preventing hair shedding. 
The fear of COVID-19 is increasing day by day, and so is the emotional, physiological and psychological stress among individuals.
Telogen effluvium is a temporary post-covid complication and may go away in some time, as said by experts. However, if you notice a sudden increase in the hair fall which does not go away even after several months, consult a medical expert for effective treatment.
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