Patient Recovery from COVID-19 Infections: Follow-Up of Hair, Nail, and Cutaneous Manifestations

Abstract

Background. COVID-19 is a pandemic disease worldwide. Although cutaneous manifestations may present in affected patients, there have been limited studies on the cutaneous findings and hair and nail abnormalities after discharge. Objective. To establish the cutaneous manifestations, hair and scalp disorders, and nail abnormalities in patients who recovered from COVID-19 infections. Methods. A retrospective chart review and telephone interviews were conducted to determine the cutaneous manifestations, hair and scalp disorders, and nail abnormalities of patients aged over 18 years who were diagnosed with COVID-19 infections at Siriraj Hospital, Bangkok, Thailand, between January and June 2020. Results. Ninety-three patients with prior COVID-19 infections participated in the study. The COVID-19 severity had been mild for most (71%). Cutaneous manifestations were reported in 8 patients (8.6%), with the common skin conditions being maculopapular rash and urticaria. The onsets of the skin conditions were before admission (1%), during admission (4.3%), and after discharge (3.2%). Increased hair shedding was also reported in 22 patients (23.7%), with a female predominance. Three patients were affected during admission, while the others were affected after discharge. The patients with moderate, severe, and critical COVID-19 infections experienced significantly more hair shedding than those with asymptomatic and mild diseases. Only 2 patients with mild COVID-19 disease reported nail abnormalities (chromonychia and brittle nails). Conclusions. Cutaneous manifestations, hair disorders, and nail abnormalities can occur in patients with COVID-19 after their discharge from hospital. Patients should therefore be followed up in anticipation of dermatological problems.

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

“…A total of 632 patients with a history of COVID-19 infection were included from 19 studies. 8,9,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Out of these 632 patients, 465 patients reported hair loss after recovery from COVID-19 and were subsequently diagnosed with acute TE. The median age of these patients was 44 years (which ranged from 34 to 64 years), with 67.5% of them being female.…”

Comparative Study of Early Impacts of Post-COVID-19 Pneumonia on Clinical Manifestations, Pulmonary Function, and Chest Radiographs

“…The greater lung and systemic inflammation might need more time to resolve than that in non-severe patients [29]. Skin manifestations such as maculopapular rash and urticaria were reported during active COVID-19 and after hospital discharge [34]. However, the symptoms described in this study were assessed using a patient-reported questionnaire, so we did not explore the details of the skin rash and its relationship with clinical severity during admission.…”

The role of SARS‐CoV‐2 infection and its vaccines in various types of hair loss

“…51 Deterioration of scalp psoriasis, with accompanying alopecia, has also been reported in SARS-CoV-2 infected patients. 52 Anagen effluvium (AE) is another pattern of hair loss in the context of SARS-CoV-2 infection, which is less common than TE. It is characterized by the abrupt excessive hair loss during the acute phase of an infection, including COVID-19 and presents with a non-scarring alopecia with fracturing of the hair shaft.…”

“… 51 Deterioration of scalp psoriasis, with accompanying alopecia, has also been reported in SARS‐CoV‐2 infected patients. 52 …”

“…Thus, it is reasonable that SARS‐CoV‐2 infected patients, or even those in concern of getting infected experience flares of SD, leading to increased rate of alopecia 51 . Deterioration of scalp psoriasis, with accompanying alopecia, has also been reported in SARS‐CoV‐2 infected patients 52 …”