A systematic review of acute telogen effluvium, a harrowing post‐COVID‐19 manifestation

Abstract

This systematic review focuses on the clinical features, physical examination findings, outcomes, and underlying pathology of acute telogen effluvium (TE), a type of diffuse hair loss, occurring in coronavirus disease 2019 (COVID‐19) recovered patients. MEDLINE/PubMed and Embase databases were queried till October 2021 to identify studies reporting acute TE occurring after COVID‐19 recovery. Data were obtained from 19 studies, which included 465 patients who were diagnosed with acute TE. The median age of these patients was 44 years and 67.5% were females. The most common trichoscopic findings were decreased hair density, the presence of empty follicles, or short regrowing hair. The mean duration from COVID‐19 symptom onset to the appearance of acute TE was 74 days, which is earlier than classic acute TE. Most patients recovered from hair loss, while a few patients had persistent hair fall. Our results highlight the need to consider the possibility of post‐COVID‐19 acute TE in patients presenting with hair fall, with a history of COVID‐19 infection, in the context of COVID‐19 pandemic. Despite being a self‐limiting condition, hair loss post‐COVID‐19 is a stressful manifestation. Identifying COVID‐19 infection as a potential cause of acute TE will help the clinicians counsel the patients, relieving them from undue stress.

Post‐COVID-19 syndrome: assessment of short- and long-term post-recovery symptoms in recovered cases in Saudi Arabia

“…These results match those of a meta‐analysis that showed the prevalence of depression, anxiety, and insomnia as 15.97%, 15.15%, and 23.87%, respectively [ 39 ]. Of the study participants, 10.1% reported hair loss similar to those in one study where 24% reported hair loss on average 110.9 days after disease onset [ 40 ].…”

Characterization of long COVID-19 manifestations and its associated factors: A prospective cohort study from Iran

“…Telogen effluvium (TE) is a type of diffuse hair loss which occurs after COVID-19 recovery. In a study composed of 465 cases diagnosed by hair loss, a mean duration of 74 days from COVID-19 symptom initiation to acute TE was estimated [ 32 ].…”

Intermittent chronic telogen effluvium with an unusual dermoscopic finding following COVID‐19

“…According to a recent systematic review, patients with post‐COVID‐19 TE have a median age of 44 years, with the predominant dermoscopic findings being decreased hair density, empty follicles and short regrowing hair. 11 The age of our patient deviated considerably from this typical disease picture. While our patient did have empty follicles on dermoscopy, the unprecedented finding of bayonet hair was documented, along with oblique tapered hair fractures.…”

“…Recent studies indicate an association between high levels of pro‐inflammatory cytokines (interleukin‐6, interleukin‐1β, interferon, and metalloproteinases 1 and 3) and acute TE. 10 , 11 , 12 Furthermore, the activation of the coagulation cascade secondary to COVID‐19 decreases the concentration of anticoagulant proteins, 13 which may induce the formation of microthrombi that occlude the blood supply of hair follicles. 14 Direct infection of the hair follicle has also been implicated, 15 with an early onset of TE suggesting this mechanism.…”