A prospective cross-sectional study on post COVID-19 hair loss at a tertiary care hospital

Abstract

Severe acute respiratory virus syndrome coronavirus 2 (SARS-CoV-2) was responsible for coronavirus disease (COVID-19) pandemic, which resulted in global health care crisis. As patients recovered from COVID-19 infection, hair loss was increasingly observed as a distressing symptom. We conducted a prospective cross-sectional study of patients presenting with post COVID-19 hair loss between July to December 2021 at a tertiary care centre in north India. Detailed history, clinical examination, trichoscopy and biochemical tests were performed and recorded. COVID-19 disease severity was assessed based on the duration of COVID-19 infection and place of management (home or hospitalized). The study included 120 patients with mean age being 39.6 years. There was female preponderance. Majority of the patients (87%) were treated at home and 43.3% had COVID-19 infection for >2 weeks. Mean visual analog scale (VAS) score for stress was 5.25. Vitamin D deficiency was present in 56.7% and low ferritin in 30% of cases. Mean time of onset of hair loss post COVID-19 was 49 days. Patients mainly presented with diffuse (72.4%) and patterned hair loss (31.6%). Trichodynia was present in 15.8% of cases. The degree of hair loss was severe in 55.8% of the subjects, predominantly in older age group and females. Positive hair pull test was seen in 65% of patients. Most common trichoscopic features included single hair follicles’ (81.7%) and vellus hair >10% (60%). Trichoscopy can aid in unmasking co-existing patterned hair loss in patients presenting clinically with diffuse hair loss. Patients with COVID-19 infection for > 2 weeks had significantly more severe hair loss and VAS score. Trichoscopic findings of vellus hair >10% and empty hair follicles were more frequent in patients who were hospitalized for COVID-19 infection.