Telogen effluvium as a manifestation of SARS-CoV-2 infection
, 1, 2, 3, 3
Abstract
We describe the case of a 44-year-old female patient, who presented to a dermatologist with increased hair loss 5 months after COVID-19 and one month after the second immunization with Pfizer and BioNTech Comirnaty vaccine. The purpose of this study is to demonstrate the importance of SARS-CoV-2 virus infection in the pathogenesis and treatment planning of telogenetic alopecia based on a medical case. The transition of the hair cycle from anagen to telogen phase is shortened under the influence of COVID-19 (to an average of about 50 days) and additionally this period is shorter as compared to classical telogenetic alopecia, in which the transition is usually observed after 3–4 months. The cause of excessive hair loss may be cytokine storm activation, vitamin and mineral deficiency, immune response and stress. Treatment targeting the factors involved in etiopathogenesis should therefore be implemented. The topic of complications following SARS-CoV-2 virus infection is particularly timely. There are many scientific studies addressing the aspect of post-infection complications. However, these are mainly preliminary observations. This article points out the need for a study of post-COVID-19 alopecia on a large group of people, as too late diagnosis of excessive hair loss, or lack thereof, can cause irreversible consequences (significant hair thinning and even complete baldness).
Keywords: COVID-19SARS-CoV-2telogen effluviumhair loss
References
- Rossi A, Magri F, Sernicola A, et al. Telogen effluvium after sars-cov-2 infection: a series of cases and possible pathogenetic mechanisms. Skin Appendage Disord. 2021; 21: 1–5.
- Starace M, Iorizzo M, Sechi A, et al. Trichodynia and telogen effluvium in COVID-19 patients: Results of an international expert opinion survey on diagnosis and management. JAAD Int. 2021; 5: 11–18.
- Moreno‐Arrones OM, Lobato‐Berezo A, Gomez‐Zubiaur A, et al. SARS-CoV-2-induced telogen effluvium: a multicentric study . J Eur Acad Dermatol Venereol. 2021; 35(3): e181–e183.
- Costela-Ruiz VJ, Illescas-Montes R, Puerta-Puerta JM, et al. SARS-CoV-2 infection: The role of cytokines in COVID-19 disease. Cytokine Growth Factor Rev. 2020; 54: 62–75.
- Tosti A, Misciali C, Bardazzi F, et al. Telogen effluvium due to recombinant interferon alpha-2b. Dermatology. 1992; 184(2): 124–125.
- Kwack MiH, Ahn JiS, Kim MK, et al. Dihydrotestosterone-inducible IL-6 inhibits elongation of human hair shafts by suppressing matrix cell proliferation and promotes regression of hair follicles in mice. J Invest Dermatol. 2012; 132(1): 43–49.
- Mandt N, Geilen CC, Wrobel A, et al. Interleukin-4 induces apoptosis in cultured human follicular keratinocytes, but not in dermal papilla cells. Eur J Dermatol. 2002; 12(5): 432–438.
- Xiong Y, Harmon CS. Interleukin-1beta is differentially expressed by human dermal papilla cells in response to PKC activation and is a potent inhibitor of human hair follicle growth in organ culture. J Interferon Cytokine Res. 1997; 17(3): 151–157.
- Hadshiew IM, Foitzik K, Arck PC, et al. Burden of hair loss: stress and the underestimated psychosocial impact of telogen effluvium and androgenetic alopecia. J Invest Dermatol. 2004; 123(3): 455–457.
- Cheung EJ, Sink JR, English Iii JC. Vitamin and mineral deficiencies in patients with telogen effluvium: a retrospective cross-sectional study. J Drugs Dermatol. 2016; 15(10): 1235–1237.
- Jothimani D, Kailasam E, Danielraj S, et al. COVID-19: Poor outcomes in patients with zinc deficiency. Int J Infect Dis. 2020; 100: 343–349.
- Demir M, Demir F, Aygun H. Vitamin D deficiency is associated with COVID-19 positivity and severity of the disease. J Med Virol. 2021; 93(5): 2992–2999.
- Chéret J, Bertolini M, Ponce L, et al. Olfactory receptor OR2AT4 regulates human hair growth. Nat Commun. 2018; 9(1): 3624.
- Piccolo D, Crisman G, Conforti C, et al. Trichobiolight: A new, effective protocol in the treatment of androgenetic alopecia and telogen effluvium. Dermatol Ther. 2021; 34(2): e14799.
- Petrov A, Vasileva M. Effect of platelet-rich plasma on diffuse effluvium in post-COVID-19 infection. Our Derm Online. 2021: 267–269.
- Nguyen B, Tosti A. Alopecia in patients with COVID-19: A systematic review and meta-analysis. JAAD Int. 2022; 7: 67–77.
