Dr Svitlana Soroka MB BS
INTRODUCTION
Hair fall associated with fever is a phenomenon that has intrigued medical professionals and individuals alike for many years. While fever is commonly understood as a symptom of an underlying illness or infection, its connection to hair loss may not be immediately apparent. However, numerous studies have shown a correlation between fever episodes and increased shedding of hair. In this essay, I will explore the various factors that contribute to hair fall during febrile episodes, including physiological changes in the body, immune system responses, and the impact of fever on the hair growth cycle.
AETIOLOGY
The aetiology of hair fall associated with fever is multifactorial and involves a combination of physiological, immunological and inflammatory processes. During a fever episode, the body undergoes various changes in response to infection or illness, which can indirectly affect the hair growth cycle.
Physiological Changes: Fever triggers a cascade of physiological responses in the body, including increased metabolic rate, elevated levels of stress hormones such as cortisol and alterations in blood circulation (Boekstegers et al, 2023) These changes can disrupt the normal functioning of hair follicles and lead to an accelerated shedding phase.
Immune System Response: Fever is often a sign of an underlying infection and the immune system responds by releasing pro-inflammatory cytokines to combat pathogens. While inflammation is a crucial part of the body’s defence mechanism, excessive or prolonged inflammation can negatively impact hair follicles and disrupt their growth cycle.
Stress and Hormonal Imbalance: Fever and illness can induce physical and emotional stress on the body, leading to hormonal imbalances. Elevated levels of stress hormones like cortisol can disrupt the hair growth cycle and push more follicles into the resting phase, resulting in increased hair shedding.
Nutritional Deficiencies: During fever, the body’s demand for nutrients increases as it works to fight off infection. Nutritional deficiencies, particularly of essential vitamins and minerals like vitamin D, vitamin B12, iron, and zinc, can compromise hair health and contribute to excessive hair loss.
Medications and Treatments: Certain medications used to manage fever or underlying infections may have side effects that impact hair growth. For example, antibiotics, antiviral drugs and corticosteroids can disrupt the hair cycle and lead to temporary hair loss as a secondary effect.
Fever, Cortisol and Hair Loss
Cortisol, often referred to as the “stress hormone,” plays a crucial role in various physiological processes, including metabolism, immune response, and stress regulation. While cortisol is essential for maintaining homeostasis in the body, chronically elevated levels or fluctuations in cortisol levels, can have adverse effects on hair health and may contribute to hair loss.
Elevated cortisol levels are associated with a reduction in the production and premature degradation of substances like proteoglycans and hyaluronans, crucial for regulating hair follicle functions (Xiang et al 2016). Specifically, corticotropin-releasing factor (CRF), a pivotal hormone in the peripheral stress response, plays a significant role. Activation of CRF significantly hampers hair shaft elongation (Wang et al, 2015)
Fever, excessive stress, whether physical or emotional, can lead to an overproduction of cortisol by the adrenal glands. Elevated cortisol levels can disrupt the normal hair growth cycle and contribute to several hair-related issues, including:
Telogen Effluvium: Fever can induce a condition known as telogen effluvium, characterized by excessive shedding of hair. In telogen effluvium, stressors such as fever or illness, surgery, or emotional trauma disrupt the hair follicles’ normal growth cycle, pushing a significant number of hairs into the resting (telogen) phase. This results in increased hair shedding and noticeable thinning of the hair.
Alopecia Areata: Stress has been implicated as a trigger for alopecia areata, an autoimmune condition characterized by patchy hair loss. Cortisol and other stress-related hormones can stimulate the immune system and promote inflammation, potentially triggering an autoimmune attack on the hair follicles, in susceptible individuals.
Hair loss associated with Dengue Fever
Dengue fever, caused by the Dengue virus transmitted through mosquitoes, poses a serious health risk similar to the flu and can even be fatal in certain cases. With approximately 400 million infections occurring annually, it is a widespread infection, mainly prevalent in tropical and subtropical regions. Many cases reported in doctors practice involve patients who have recently travelled to areas such as the Caribbean, Central America, and South America, where Dengue-infected mosquitoes are prevalent. However, these mosquitoes can also be found in various parts of the world, including Africa, parts of the Mediterranean, South and Southeast Asia and other regions.
Individuals, especially tourists, are susceptible to Dengue virus transmission through mosquito bites, particularly during sunrise and sunset when mosquitoes are most active. Symptoms typically appear a few days to two weeks post-bite and resemble those of the common flu: high fever, severe headache, eye pain, joint and muscle aches, vomiting and rash. In severe cases, some individuals may experience bleeding from the gums, internal bleeding and respiratory issues, which can be life-threatening.
Hair loss is a common occurrence following Dengue fever, typically manifesting a few months after the onset of the illness and lasting for several months. This type of hair loss, known as telogen effluvium, can be quite noticeable, although the hair typically regrows within 6-9 months. The shedding eventually subsides on its own, and while there is no specific treatment for Dengue-related hair loss, it is important for individuals to focus on recovering from the illness, to promote hair regrowth (Donovan, 2018).
Hair Loss, Fever and the Spanish Flu
During the Spanish Flu pandemic of 1918-1919, hair loss was reported as one of the many symptoms experienced by those infected. The Spanish Flu, caused by the H1N1 influenza virus, was particularly severe and resulted in a wide range of symptoms, beyond the typical flu-like manifestations. In addition to fever, cough, sore throat, and body aches, individuals affected by the Spanish Flu often experienced hair loss as a result of the physiological stress, placed on the body by the virus.
In 1919, H.H. Hazen documented in the Journal of the American Medical Association, the cases of 50 individuals who experienced hair loss following influenza, with 47 of them being women (Hazen, 1919). It was observed that 90% of these individuals developed a fever exceeding 102.5°F (39.2°C), which was identified as the probable precipitating factor. Hair shedding typically commenced approximately 9 weeks after the onset of fever. Notably, all patients experienced prompt regrowth of hair. This study, conducted over a century ago, continues to be widely cited as a seminal investigation, highlighting the fever threshold most likely associated with telogen effluvium in adults.
Moreover, hair loss during the Spanish Flu pandemic was likely attributed to several factors, including the direct impact of the virus on the body’s immune system and the body’s response to the infection. Fever, a common symptom of influenza, can lead to increased shedding of hair, due to the stress it places on the body. Additionally, the immune response triggered by the virus can cause inflammation and damage to hair follicles, resulting in temporary hair loss known as telogen effluvium.
It is important to note, that while hair loss was reported during the Spanish Flu pandemic, it was likely a transient and temporary condition for most individuals. As the body recovered from the infection, hair growth typically resumed, and any hair loss experienced during the illness, was often reversed.
In conclusion, fever can be associated with temporary hair loss, primarily due to conditions like telogen effluvium, which disrupt the normal hair growth cycle in response to physical or emotional stress. While fever itself does not directly cause hair loss, it can contribute to hair shedding by triggering changes in the body’s physiological processes. Most cases of fever-induced hair loss are temporary and resolve on their own, once the underlying cause, such as an infection, is treated and the body’s temperature returns to normal.
However, it’s essential to monitor hair loss patterns and seek medical attention, if hair shedding persists or is accompanied by other concerning symptoms. Chronic or progressive hair loss conditions, may require further evaluation and management by a healthcare professional. to address underlying medical issues and promote hair regrowth.
REFERENCE
Boekstegers A, Schmidt H, Kurzay M, Vallée T, Jung E, Dubinski I, Maxwell R, Schmid I (2023) Cortisol response in children with cancer and fever during chemotherapy: A prospective, observational study using random serum cortisol levels. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10166925/ (Accessed 19/03/2014)
Donovan J (2018) Hair loss from Dengue Fever https://donovanmedical.com/hair-blog/dengue (Accessed 19/03/2024)
HAZEN, H,H (1919) POSTINFLUENZAL ALOPECIA, JAMA
Xiang L, Sunesara I, Rehm KE, Marshall GD Jr. 2016 Hair cortisol concentrations are associated with hair growth rate. Neuroimmunomodulation. PubMED
Wang L, Guo LL, Wang LH, et al. (2015) Oxidative stress and substance P mediate psychological stress-induced autophagy and delay of hair growth in mice. Arch Dermatol Res. 2015. PubMed
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