Recurrence of alopecia areata after covid‐19 vaccination: A report of three cases in Italy

Abstract

Background Common COVID‐19 vaccines side effects are pain at the injection site, muscle pain, fever, headaches, fatigue. Possible immune‐related side effects in predisposed individuals have not been established so far. Materials and Methods We report three cases of recurrence of alopecia areata (AA) occurred after the first dose of COVID‐19 vaccine. Results All patients had previous episodes of AA with total hair regrowth and stable remission during the months preceding the vaccination. Rapid hair loss occurred 2‐3 weeks after BNT162b2 mRNA (patient 1) and AZD1222/ChAdOx1 vaccine (patient 2 and 3), with widespread hair loss in two cases and a single patch of the vertex in one case, with typical trichoscopic features of AA. Discussion Both BNT162b2 mRNA and AZD1222/ChAdOx1 vaccines share the same goal of inducing the immune system, with antibodies production and Th1 cells activation with release of pro‐inflammatory cytokines. Thus, in patients with pre‐existing inflammatory dysregulated pathways, the interaction between the immune system and vaccines may enhance other autoimmune mechanisms. In our cases, we speculate that vaccine may have induced the hair loss focusing on components having a key role in both COVID‐19 vaccination and AA pathogenesis. Conclusion This report may help to collect new data concerning possible immune‐related effects of vaccines. Certainly, only three cases are not sufficient to draw conclusion, thus a large‐scale study is necessary. Immune‐mediated side effects remain a rare event, thus the benefits of COVID‐19 vaccines outweigh the risk of disease flares and we strongly recommend it in all eligible patients with AA.

Alopecia areata after SARS-CoV-2 vaccination

“…3 A report from Italy describes 1 case of AA recurrence following Pfizer messenger RNA vaccine and 2 cases of AA recurrence following AZD1222/ChAdOx1 nCoV-19 vaccine (Oxford/ AstraZeneca). 4 Essam et al 5 also reported recurrent AA after a long period of disease quiescence in a middle-aged woman following immunization with the ChAdOx1 nCoV-19 vaccine. Furthermore, there are reports of AA in children and adults after other routine vaccinations.…”

“…Six of our 9 patients experienced hair loss within 1 month of completing their vaccine series, and 2 more experienced hair loss within 2 months. Chu et al 6 and Essam et al 5 reported hair loss between a few days to 1 week following vaccination, and Rossi et al 4 described hair loss occurring between 2 to 3 weeks after. Wise et al 8 found that 84% of hair loss in 50 reports of AA occurred within 1 month of vaccination, although they did report 1 patient with hair loss 10 weeks later.…”

A case of atopic dermatitis with alopecia universalis in a patient treated with abrocitinib

“…A similar case of vaccine-induced AA/AU has also been reported after COVID-19 vaccination. 7 The exact mechanisms driving such rare events are not yet fully understood, but vaccine-induced antibodies may intensify autoimmune disorders through JAK-signal transducer and activator of transcription activation. Despite a mild relapse of AD, the patient remains satisfied with the therapy outcome.…”

New insights into alopecia areata during COVID‐19 pandemic: When infection or vaccination could play a role

“… 3 At the same time, raised INF‐I levels upregulated MHC class I proximal outer root sheath, favoring the loss of hair follicle immune privilege. 4 …”

“…AA has been reported after vaccinations against several pathogens, including hepatitis B virus, Influenza, Human Papillomavirus, Varicella‐Zoster, and Japanese encephalitis vaccines. 4 , 6 …”