Early-onset effluvium secondary to COVID-19: Clinical and histologic characterization

Abstract

Early-onset effluvium secondary to COVID-19: Clinical and histologic characterizationTo the Editor: As telogen effluvium (TE) is the most common manifestation of postacute COVID-19 syndrome, we read with keen interest the publication by Abrantes et al 1 reporting the clinical characteristics of 30 patients with post-COVIDe19 acute TE. We would like to commend the authors and bring some other elements to this relevant discussion.TE is a heterogeneous condition that can be elicited by multiple stimuli. 2 Headington 3 proposed 5 functional types of TE based on alternations in particular phases of the follicular cycle. Infections are thought to induce TE through the mechanism of immediate anagen release. According to this model, an acute inflammatory state converts the follicles from anagen to catagen, leading to the shedding of telogen hairs around 90 days after the infection. Interestingly, the median time for the onset of hair shedding observed by Abrantes et al 1 was 45 days after infection; in the most precocious case, it started 18 days after COVID-19.This early onset was also observed in 2 multicentric studies. Moreno-Arrones et al 4 evaluated 214 cases of acute TE after COVID-19 and noted the onset of hair shedding, on average, 57.1 days after the infection. Starace et al 5 observed early onset especially when TE was associated with trichodynia. In these cases, the latency from the infection to hair shedding occurred at an average of 3 (range, 2-7.5) weeks. 5 We recently assessed 203 hospitalized patients with confirmed COVID-19, of whom 11 (5.4%) reported hair loss with onset early during hospitalization, \30 days after the infection. Seven of them were assessed using trichoscopy, a trichogram, and a histologic evaluation. The detailed information of these cases is presented in Supplementary Table I (available via Mendeley at https://data.mendeley.com/datasets/p254jbh356/1).Clinically, all the cases presented a positive pull test result. Trichoscopy did not reveal broken hairs, anisotrichosis, or yellow dots, but it did reveal some empty follicles. The trichogram obtained from the vertex revealed[10% dystrophic anagen hairs (Fig 1) and [20% telogen hairs in all the cases. Histologically, there was predominance of anagen terminal follicles, no relevant miniaturization ([10%), and no cases showing [25% telogen follicles. No

Reply to early-onset effluvium secondary to COVID-19 and body hair effluvium

“…To the Editor: We agree with the points made by Miola et al 1 about the possibility of dystrophic anagen effluvium in cases assumed to be diagnosed with acute telogen effluvium, particularly in more severe hospitalized cases, when associated with early onset.…”

“…As pointed out, some scalp biopsies showed no evidence of inflammation. 1 Thus, in the context of therapeutic initiation for COVID-19, therapy could have a benefit by halting respiratory involvement progression, improving oxygenation and physical stress, thus preserving the homeostasis of multiple organs, including the skin.…”

Characteristics of hair loss after COVID‐19: A systematic scoping review

“…Table 2 delineates the demographics and clinical characteristics of patients with hair loss and COVID‐19 ( n = 58), with a predominance of female patients (17.2% male and 82.8% female). 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 Hair loss type was predominately TE (74.1%), with the next most common hair loss type being early‐onset effluvium (12.1%). Only a small number of individuals had other types of hair loss including AA (5.2%), fibrosing alopecia (3.4%), and one individual each with alopecia areata totalis (1.7%), alopecia areata universalis (1.7%), and anagen effluvium (1.7%).…”

Therapy experience in alopecia after COVID-19

“…Как понимание того, каким образом патологическая динамика потери волос связана с циклом роста волос и целостностью волосяного фолликула, так и понимание того, что у нарушений, связанных с потерей волос, может существовать множество причин, являются предпосылкой для оказания соответствующей помощи пациенту. Анализируя причинно-следственные связи при «постковидной» алопеции, необходимо обратить внимание на целый комплекс факторов, воздействующих на волосяной фолликул [7][8][9].…”