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The unforeseen side effects of COVID-19: Understanding hair shedding in the pandemic

  • Expert from the Institute of Trichologists explains the reasons behind this concerning condition which is reportedly affecting an increasing number of patients who had felt they were on the road to recovery…

 

Fatigue, persistent cough, muscle weakness and even memory loss. These are just some of the debilitating long-term outcomes that some patients are facing in the aftermath of COVID. However, in recent weeks, a number of celebrity testimonials (such as American actress Alyssa Milano and British actress and TV personality Linda Lusardi) have brought to the fore the relatively new, yet particularly distressing side-effect of post-COVID hair shedding.

 

Clinical Trichologist Eva Proudman helps shed some light as to why many people who have suffered from COVID-19 are now also experiencing dramatic hair shedding (telogen effluvium) months after their initial coronavirus diagnosis.

 

“It’s well known that telogen effluvium – to give excess hair shedding its clinical name- can be stimulated by acute illness and high fever which explains why numerous COVID-19 patients who suffered at the critical level back in March or April may now be experiencing hair shedding. Stress, shock or trauma can also bring on telogen effluvium – emotions and experiences that many COVID-19 patients have felt during these worrying few months. Increased hair shedding will most probably be a temporary issue and, reassuringly, it is unlikely that you will permanently lose any hair. However, I do completely understand that it can be very frightening to experience and very stressful to look in the mirror and see the impact of hair shedding.

 

“So, if you are worried, I do urge post-COVID patients to seek medical advice – first via your GP, who should refer you to a dermatologist or recommend a specialist trichology consultation – to confirm the condition and to ensure that you are doing all you can to manage and maintain your hair to bring it back to its normal, healthy state.

 

“There has also been some interesting global research into the link between COVID-19 and telogen effluvium. For example, a research team at the School of Medicine at Indiana University found that almost 1/3 of 1,500 people surveyed reported hair shedding as a longer-term effect of COVID-19 symptoms. Furthermore, the School of Medicine at Uşak University in Turkey reported around a 33% increase in patients being diagnosed with alopecia in recent months compared to before the pandemic.

 

Eva continues; “Of course, it is not only those who have suffered with COVID-19 that are experiencing hair shedding. As I mentioned, lockdown has been a stressful and traumatic time for many of us and these emotions alone can trigger telogen effluvium. I have also seen a marked increase in cases of Alopecia Areata (patchy hair loss) across my trichology clinics due to increased stress and anxiety during this time.

Furthermore, in lockdown we have all had to adapt to spending a lot more time indoors which can restrict our access to sunlight and vitamin D.

“Hair follicles have vitamin D receptors which in simple terms stimulate hair growth, so if your vitamin D level is low or deficient then your hair is at risk of shedding excessively. Now that we have been allowed significantly more freedom to roam – and the weather has largely been so good across the UK – I strongly recommend regular outdoor activity and exercise, firstly to help lift your mood and ease your stress levels, and secondly to allow that all important access to sunlight. This can be really effective in preventing and coping with hair shedding.

 

“Understandably, telogen effluvium in any context can be scary for those experiencing it, and its occurrence as a post-recovery symptom of COVID-19 is just the latest unforeseen symptom to be documented after breathlessness, muscle degeneration and fatigue.

 

Becoming an undergraduate during a pandemic: Priory expert offers advice

Over the next few weeks, thousands of young people across the country are preparing for that well-established rite of passage – heading to university for the start of the new academic year.

 

But restrictions caused by COVID-19 will make starting university this year a unique, and potentially difficult, experience; many universities are having to adapt courses to online learning rather than face-to-face lectures while some are requesting students only socialise with those living in their halls of residence.

 

And studying for a degree already means dealing with the combined stress of academic work, tight finance and much higher levels of debt than in the past. The pandemic, and concerns about a second wave, add another layer of pressure to this mix.

 

The stresses placed on students can have serious consequences both on their mental health – and their future career; official figures show that two thirds of universities and colleges have seen an increase in the last five years in the proportion of students who ‘drop out’.

 

And only one in four (27%) of existing students feels that their university provides adequate mental health support, according to the newly-released NatWest Student Living Index 2020.

 

This is despite efforts made by many universities in recent years to tackle the mental health crisis among students head-on – the pressure to socialise (albeit with social distancing thrown in this year), to live independently in an unfamiliar environment, and to thrive academically.

 

Every year there are widely reported incidents involving young people and excess alcohol. Others struggle with acute feelings of loneliness, fear they have chosen the wrong course or university, and homesickness.

 

However, as reported in the Hippocratic Post this week, against this worrying backdrop there are plenty of pragmatic steps undergraduates can take to look after themselves and their mental health as they adjust to student living.

 

Firstly, starting university can be an exhilarating experience, combining being away from the watchful eyes of parents with being surrounded by like-minded teens. But it may not feel like that for everyone. Priory consultant psychiatrist Dr Andrew Iles says; “Do not feel pressured into drinking alcohol, or at least more than you would like to, and remember that you are your own person. Stepping outside of your comfort zone to please others is never going to work out well.”

 

University is primarily about studying, not partying, but this brings its own pressures. Students who are used to being at the top of their class may suddenly find themselves surrounded by people of equal or higher ability. Undergraduates should remember that what they are feeling is perfectly normal. “A significant number of my patients are university students and practicing in Oxford means that I am used to seeing people who fear that they are not intelligent enough to keep up with university life,” says Dr Iles. He continues; “Usually this is simply untrue, but it does not stop people experiencing ‘imposter syndrome’.”

 

And, this new phase of academic life may often be the first-time young people have been required to structure their own reading and learning, and some are not prepared. “Adapting from A levels and other courses like the International Baccalaureate and BTECs, is tough”, says Dr Iles. “The structured learning environment of sixth form and further education colleges is replaced with much greater emphasis on self-directed study and learning objectives may become less well-defined.”

 

Because there will be a dizzying array of things to do and people to meet, students need to remember that there is only so much a person can get through, and that taking the time to rest and recuperate is very important. “Speak to any established undergraduate and they will tell you that staying up late and the pressure to find new friends is exhausting. Burning the candle at both ends leaves many feeling homesick and isolated”, says Dr Iles.

 

If students do find the whole experience starts to feel overwhelming, it helps to remember that everyone is in the same situation. Dr Iles reminds new starters that; “You have worked hard to get into university, so try and remember that many people will experience similar problems when they start. However, some people may have greater problems, maybe because of existing mental illness or maybe because they are experiencing a mental health condition for the first time. Should you find yourself in this situation, make sure you tell someone. It is never good to suffer in silence.”

 

So, it’s good to remind yourself – or friends you might be concerned about –  if you’re feeling stressed or anxious, there are people to help, whatever the underlying cause. You can access medical professionals such as GPs, or counsellors, psychologists, welfare advisers, university counselling services or student union representatives. Your GP may also refer you to a psychotherapist or psychiatrist – confidential services that will not affect your job prospects negatively (a common worry).

 

 

 

 

Two internationally renowned cardiologists to host live webinar on new guidance surrounding ‘safe exercise’ in the Covid-era and how to prepare for a return to sport

NEW PAPER IN THE EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY PROVIDES EXPERT GUIDANCE FOR ‘SAFE EXERCISE’ IN THE COVID-ERA & HOW TO PREPARE FOR A RETURN TO SPORT

  • Recommendations led by a team of UK-based cardiac researchers receive endorsement from the European Section for Sports Cardiology & Exercise
  • Published paper provides practical answers to key questions posed by the international sporting community, ahead of a phased return to some professional sports, such as the Premier League football
  • Evidence shows that regular, moderate exercise strengthens the immune system and may reduce risk of viral infection
  • Athletes can suffer psychological problems due to “sudden withdrawal of training stimulus” during lockdown
  • Research shows that in up to 30% of COVID-19 patients admitted to hospital, a significantly raised troponin level was identified, often leading to ventilation and poorer outcomes
  • Algorithm to guide athletes, club doctors and sporting bodies to ensure safe return to training in those with confirmed or suspected COVID-19
  • Two internationally renowned cardiologists to host live webinar on MONDAY 15 JUNE @3PM to talk through the Guidelines and help unpick myths about COVID-19 & sport

The impact of the COVID-19 pandemic on the global sporting community has been immense, disrupting fixtures, contracts, training schedules and those mass-participation events once thought to be immovable and untouchable, such as the London Marathon and the 2020 Olympic Games.

But it is the impact – both physiological and psychological – on individual participants that is coming under greater scrutiny as a gradual loosening of the international lockdown starts to see training and competition slowly reintroduced. And with this, comes many pertinent questions and concerns from club doctors and athletes alike.

In response, a new published paper is helping all stakeholders in professional and elite sport to navigate evolving research and advice and to effectively and safely prepare for a return to competitive sport in the current and post-pandemic era.

The publication originated from a team of Research Fellows funded by Cardiac Risk in the Young (CRY) and is led by Dr Michael Papadakis and Professor Sanjay Sharma from the unit of Sports Cardiology and Inherited Cardiac Diseases at St George’s University, London.

He explains; “It’s so important to highlight – whether an elite or recreational or even a beginner athlete – is that is still ‘safe’ to exercise during this COVID-era. There is evidence that moderate exercise performed for 20-30 minutes, 3-4 times per week strengthens the immune system and reduces the risk of viral infection. Scientific studies have shown that this regular moderate exercise prior to developing a potentially serious viral infection such as flu protects people dying from it.

“Interestingly, previous research has shown that people who continued to remain active during the 1998 Hong Kong flu were more likely to survive compared to people who did not perform any exercise.

Although athletes are accustomed to exercising more intensively than the general population, it is recognised that rigorous exercise causes stress on the body, leading it to become run down and more prone to infections. The new publication states there is currently no evidence to suggest that athletes are especially susceptible to COVID-19 infection, but the pragmatic position remains that athletes should not try to exceed the intensity of their usual training programme in regions of the world where the pandemic is still at its peak.

From the early days of the pandemic, there was concern of a small percentage of patients who required hospital admission displaying signs of inflammation of the heart muscle – a condition known as myocarditis.

It is unlikely that a COVID-19 patient’s heart will be affected if they are only presenting mild symptoms and are adopting self-care at home – but patients do need to be aware of chest pain that may be made worse by breathing in deep, increasing breathlessness and palpitations (racing heart). In such cases, patients should contact their GP, Club Doctor or emergency services – and athletes should not exercise if experiencing any of these symptoms.

Dr Papadakis explains; “COVID-19 may affect the heart in a number of different ways. One of the most serious implications is myocarditis, which can be diagnosed by measuring levels of a protein termed cardiac troponin in the blood, which is released by damaged heart muscle. In the case of an elite athlete, this blood test may now be performed by the club doctor or a recommended medical institution or clinic that has the facilities and capacity to test without the risk of anyone else becoming infected.

“If the cardiac troponin level in blood is increased, the doctor will also arrange an electrical tracing of the heart (ECG) and a heart scan and an appointment (potentially still remotely with a cardiologist.”

“Myocarditiscan become very serious, especially if people continue to exercise. This can cause the heart to become damaged permanently and may even cause sudden death.

“So, all guidance states that all exercise should be stopped completely for at least 3 months, to rest the heart. Depending on the results of the follow-up heart scan, the cardiologist may also prescribe medications if the heart appears to have been weakened by the infection. The patient will have another assessment after 3 months to determine if their heart is strong enough to return to sport; some athletes may need to rest for another 3 months.

“Our publication includes an algorithm to guide athletes, club doctors and sporting bodies as to when evaluation by a heart specialist is necessary to ensure safe return to training in those with confirmed or suspected COVID-19. It provides a realistic approach which balances the concerns of the impact of COVID-19 on the heart versus subjecting athletes to unnecessary investigations, taking into consideration available resources for the elite but also for the millions of recreational exercisers.”

The new publication, supported by CRY’s research programme, highlights myriad issues and questions including;

  • specific advice for Marathon runners
  • concerns about whether all athletes should be tested for COVID-19 before returning to their season
  • are they more or less susceptible to becoming infected or experiencing serious side effects?
  • does management of the virus differ in athletes to the general population?
  • what are the effect of “detraining” on an elite athlete?
  • to what level it is safe to train at – during the current pandemic?

To address and discuss these many issues, Dr Papadakis and Professor Sharma will be hosting a live webinar on MONDAY JUNE 15TH@ 3PM There will be no charge made to those wishing to attend the session (whether they are athletes, Club officials and medics, general public, or members of the media) but there will be an opportunity to make a small donation to help support CRY’s research programme through the COVID-19 crisis.

If you would like to register for the webinar go to www.c-r-y.org.uk/covid19

Dr Steven Cox, CRY’s Chief Executive, adds; “We are pleased that our research team have been able to provide the most up to date advice for both patients and the medical community, as well as young people who want to stay as fit and healthy as possible throughout this crisis. This is an incredibly challenging time for everyone and this guidance will help to give people some confidence in their decisions when they are surrounded by so much uncertainty.”

 

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