The Journal of Dermatology: June, 2022

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a pandemic by the World Health Organization, and COVID-19 continues to have a major impact on society.

Numerous studies have reported impaired health sequelae after COVID-19 recovery, one of which is hair loss. Individuals with hair loss experience a substantial mental burden, which potentially hinders their social life.

However, few studies have systematically analyzed the details including hair loss. Therefore, authors conducted a narrative review using PubMed on the frequency, associated comorbidities, disease characteristics, and treatment of Hair Loss After SARS-CoV-2 Infection (HLASCI).

Hair Loss After SARS-CoV-2 Infection (HLASCI) is speculated to be composed of a heterogeneous population, with the onset or exacerbation of telogen effluvium (TE), anagen effluvium, androgenetic alopecia (AGA), and alopecia areata (AA) reported as possible underlying mechanisms.

Among these, acute TE is thought to be the primary cause of HLASCI, with COVID-19 treatment and TE improvement being considered crucial for HLASCI management.

FIGURE 1

A representative case of HLASCI. A 57-year-old female with a two-month history of progressive hair loss that started approximately 2 months after SARS-CoV-2 infection (confirmed by polymerase chain reaction). (a) Decrease in hair density with regrowing hairs observed on the frontal scalp. (b) Upright regrowing hairs and a vacant follicular ostia as observed by trichoscopy. (c) Shed hairs with club-shaped root. (d) Spontaneous and gradual decrease in hair shedding, typical of telogen effluvium. HLASCI, hair loss after severe acute respiratory syndrome coronavirus 2 infection; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

FIGURE 2

Theoretical explanation of HLASCI etiopathogenesis/pathophysiology. Various factors such as intrinsic susceptibility (e.g. presence of androgenetic alopecia; AGA?), presence of underlying diseases, and medications may predispose individuals to COVID-19. Infection with SARS-CoV-2 results in a cytokine storm. Hair follicles by themselves can be targets of SARS-CoV-2. Induced anagen hair follicle damage can lead to telogen effluvium (TE), anagen effluvium and contribute to exacerbation of alopecia areata (AA). HLASCI, hair loss after severe acute respiratory syndrome coronavirus 2 infection; COVID-19, coronavirus disease 2019; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

TAKE-HOME MESSAGE

In this systematic review, 21 articles analyzing hair loss after SARS-CoV-2 infection were included. The most commonly reported hair loss was telogen effluvium (TE), which was observed after a median of 2 months after infection.

Overall 5 articles reported alopecia areata (AA) after SARS-CoV-2 infection, including new onset and rapid progression of pre-existing AA.

Spontaneous recovery of TE can be expected once infection reduces; however, faster improvement in symptoms is expected to reduce the mental and social burden of patients.

A total of 11 articles focusing on TE treatment showed that oral and topical minoxidil had the highest efficacy in treating this condition. Topical minoxidil may provide relief from HLASCI, but future clinical research is warranted to confirm this observation.

COVID-19 is associated with acute Telogen Effluvium (TE) and exacerbation of Alopecia Areata (AA). Oral and Topical Minoxidil are effective treatment options.