COVID‐19 induced telogen effluvium

Abstract

COVID‐19 is a febrile, infectious illness that has previously been associated with telogen effluvium (TE). However, to date, no study has been conducted to determine the incidence of TE in those who have had COVID‐19. To assess the frequency of TE in post‐COVID‐19 patients and the correlation between the development of TE and the severity of COVID‐19, to understand whether emotional stress or medications are responsible for the development of TE. Totally 204 patients with a history of SARS‐CoV‐2 infection in the last 3 months were included in the study. The diagnosis of TE was made by history of excessive hair shedding, hair pull test, diffuse or bitemporal thinning, and absence of anisotrichosis in trichoscopy. Patients who did not have any TE cause other than COVID‐19 and whose hair loss started after COVID‐19 were considered as “COVID‐19 associated TE (CATE).” We found TE in 75 (36.7%) cases and androgenetic alopecia (AGA) in 85 (41.7%) cases. CATE was present in 27.9% of cases and developed on average 53.76 (± 23.772) days after COVID‐19 real‐time reverse transcription polymerase chain reaction (RT‐PCR) positivity. The proportion of patients with CATE was numerically higher in hospitalized patients compared to outpatients (31.7% vs. 24.3%; p = 0.238); and significantly higher in women compared to men (42.3% vs. 6.2%; p < 0.001), in patients with hypertension compared to those without hypertension (40.4% vs. 23.1%; p = 0.014), and in patients who had respiratory symptoms compared to those who had not (31.7% vs. 14.0%; p = 0.021). The patients with and without CATE were similar in terms of stress level and usage of COVID‐19 medications. Patients with AGA had a higher rate of hospitalization (69.4% vs. 35.3%; p < 0.001) and a higher incidence of fever (69.4% vs. 54.6%; p = 0.033) during COVID‐19, compared to those without. TE developed in approximately one‐quarter of people who have had COVID‐19, and our study is the first to detect it. The time to onset of CATE, which was 7–8 weeks after the SARS‐CoV‐2 RT‐PCR positivity, was not much different from post‐infectious TE. Patients with severe COVID‐19 seem to be more prone to develop TE. The presence of AGA is associated with a more severe COVID‐19. During the pandemic, clinicians should consider a previous SARS‐CoV‐2 infection in patients presenting with hair loss.

Evaluation of patients with telogen effluvium during the pandemic: May the monocytes be responsible for post COVID‐19 telogen effluvium?

“…In studies in the literature, the rate of female sex in patients with TE with a history of COVID-19 has been reported between 77.9% and 92.3% similar to our study. [5][6][7]9,10,13,15 This might be explained by the fact that female patients notice hair shedding more easily due to their hair length and need to consult a physician more frequently because of taking hair loss more seriously than men. 11 The use of vitamin supplements was significantly higher in the group with a history of COVID-19 in our study.…”

“… 2 , 3 , 4 In several reports, it has been stated that the average onset time of the hair shedding was 1–3 months after the diagnosis of COVID‐19. 5 , 6 , 7 , 8 , 9 , 10 …”

“… 11 The possible pathogenetic mechanisms of the development of TE after COVID‐19 have been tried to be explained with damaged hair matrix cells by cytokine storm and psychosocial and physical stress resulting from the “stay at home” orders, drugs such as heparinoids and direct viral damage to the hair follicle. 6 , 7 , 9 , 10 …”

Correlation Between Interest in COVID-19 Hair Loss and COVID-19 Surges: Analysis of Google Trends

“…There is an increasing body of evidence documenting an appreciable incidence of hair loss in patients with a past history of COVID-19 [ 1 ]. In general, COVID-19 has been accompanied by reports of increased mental health stress; this has serious implications for the psychosocial well-being of the overall population given the most recent emergence and surge of the omicron variant, characterized by unprecedented infectivity and spread [ 2 , 3 ].…”

“…In general, COVID-19 has been accompanied by reports of increased mental health stress; this has serious implications for the psychosocial well-being of the overall population given the most recent emergence and surge of the omicron variant, characterized by unprecedented infectivity and spread [ 2 , 3 ]. Since both stress and infection are potential factors leading to telogen effluvium (hair shedding), it is important to understand how the surges of the initial COVID-19 strain and subsequent variant strains have influenced public interest in telogen effluvium and hair loss [ 1 ].…”