Clinical and trichoscopic features of post-COVID-19 telogen effluvium
Keywords:
Telogen effluvium, Covid-19, Hair loss, TrichoscopyAbstract
Objective Telogen effluvium is the most common, self-limiting cause of alopecia. An association between telogen effluvium and COVID-19 has recently been reported. Methods This cross-sectional study included 75 patients at dermatology outpatient clinic. The patients were classified according to their COVID-19 history as mild, moderate, or severe. History was taken to assess the onset of hair loss. All patients were examined by hair pull test and assessed trichoscopically for the presence of follicles with a single hair, yellow dots, decreased hair density, peri pilar sign, empty hair follicles, and upright regrowing hair. Results The mean duration of hair loss in the current study was 8.55 weeks. Patients with higher severity of COVID-19 reported significantly earlier onset of hair loss. Pain and dystrophic anagen hair on pull test was observed in association with hair shedding in all patients with severe COVID-19 infection. Conclusion Post-COVID-19 telogen effluvium has a significant positive correlation with the severity of COVID-19 infection with earlier onset of hair loss, increased frequency of trichodynia, and dystrophic anagen hair.References
Malkud S. Telogen Effluvium: A Review. J Clin Diagn Res. 2015 Sep;9(9).
Andrew G. Messenger, Rodney D. Sinclair, Paul Farrant and David A. R. de Berker . Acquired Disorders of Hair. In Rook TB of dermatology by Griffiths CEM, Barker J, Bleiker TO, Chalmers R, Creamer D.9th Ed .Wiley Black well; 2016; chapter 89: 2285.
Manabu Ohyama . Telogen effluvium. In Fitzpatrick’s Dermatology in General Medicine by Goldsmith L, Katz S, Gilchrest BA, Paller AS, Leffell DJ,wolff K. 9th Ed. McGraw Hill Med. 2019; chapter 86:1507-1514.
Mysore V, Parthasaradhi A, Kharkar RD, Ghoshal AK, Ganjoo A, Ravichandran G, et al. Expert consensus on the management of Telogen Effluvium in India. Int J Trichology. 2019;11(3):107-112.
Fahham A, Nazia S, Umar F, Haris S, Ramsha A. Telogen Effluvium: A Review of the Literature. Cureus. 2020;12(5):e8320.
Yousefian F, Yadlapati S, Krejci-Manwaring J. Postpartum Alopecia. J Case Rep Med Hist. 2022;2(5).
Trüeb RM. The difficult hair loss patient: a particular challenge. Int J Trichology. 2013;5(3):110.
Leonard C. Sperling, Rodney D. Sinclair and Laila El Shabrawi-Caelen. Alopecia.In Bolognia TB of dermatology by Jorizzo J, Schaffer J, Callen J, Cerroni L, Heymann W, HruzaG] M,Patterson J, Röcken M. 4th Ed. ELSEVIER.2018.
Vázquez-Herrera NE, Sharma D, Aleid NM, Tosti A. Scalp itch: a systematic review. Ski appendage Disord. 2018;4(3):187–199.
Grover C, Khurana A. Telogen effluvium. Indian J Dermatol Venereol Leprol. 2013;79(5):591-603.
Shams S, Rathore SS, Anvekar P, Sondhi M, Kancherla N, Tousif S, et al. Maculopapular skin eruptions associated with COVID-19: a systematic review. Dermatol Ther. 2021;34(2):e14788.
Olds H, Liu J, Luk K, Lim HW, Ozog D, Rambhatla P V. Telogen effluvium associated with COVID‐19 infection. Dermatol Ther . 2021;34 (2): e1476.
Rossi A, Magri F, Sernicola A, Michelini S, Caro G, Muscianese M, et al. Telogen effluvium after SARS-CoV-2 infection: a series of cases and possible pathogenetic mechanisms. Ski appendage Disord. 2021;7(5):377–81.
Coronavirus disease 2019 (COVID-19) treatment guidelines. National Institutes of Health. Accessed October 10, 2022.
Arjel A, Pokhrel K. Telogen Effluvium and Trichodynia in Different Severity Groups of Post COVID-19 Patients. J Nepalgunj Med Coll. 2022;20(1):12–5.
Babaei K, Kavoussi H, Rezaei M, Kavoussi R. Characteristics of telogen effluvium in COVID-19 in western Iran (2020). An Bras Dermatol. 2021;96(6):688–92.
Sharquie KE, Jabbar RI. COVID-19 infection is a major cause of acute telogen effluvium. Irish J Med Sci. 2022;191(4):1677–1681.
Wei N, Elbogen E, Dan J, Chessky A, Rivera-Oyola R, Lebwohl M. Telogen Effluvium in Patients recovering from COVID-19. Ski J Cutan Med. 2021;5(5):533–7.
Moreno-Arrones OM, Lobato-Berezo A, Gomez-Zubiaur A, et al. SARSCoV-2-induced telogen effluvium: a multicentric study. J Eur Acad Dermatol Venereol. 2021;35(3):e181-e183.
Hussain N, Agarwala P, Iqbal K, Omar HMS, Jangid G, Patel V, et al. A systematic review of acute telogen effluvium, a harrowing post‐COVID‐19 manifestation. J Med Virol. 2022 Apr 28;94(4):1391–401.
Jose RJ, Manuel A. COVID-19 cytokine storm: the interplay between inflammation and coagulation. Lancet Respir Med. 2020 Jun;8(6):e46–7.
Starace M, Iorizzo M, Sechi A, Alessandrini AM, Carpanese M, Bruni F, et al. Trichodynia and telogen effluvium in COVID-19 patients: Results of an international expert opinion survey on diagnosis and management. JAAD Int. 2021 Dec;5:11–8.
Di Landro A, Naldi L, Glaser E, Paus R, Tosti A. Pathobiology questions raised by telogen effluvium and trichodynia in COVID‐19 patients. Exp Dermatol. 2021;30(7):999–1000.
Chéret J, Bertolini M, Ponce L, Lehmann J, Tsai T, Alam M, et al. Olfactory receptor OR2AT4 regulates human hair growth. Nat Commun. 2018 18;9(1):3624.
Gori A, Leone F, Loffredo L, Cinicola BL, Brindisi G, De Castro G, et al. COVID-19-Related Anosmia: The Olfactory Pathway Hypothesis and Early Intervention. Front Neurol. 2020; 10:11.
Miola AC, Florêncio LC, Bellini Ribeiro ME, Alcântara GP, Müller Ramos P, Miot HA. Early-onset effluvium secondary to COVID-19: Clinical and histologic characterization. J Am Acad Dermatol. 2022;86(5):e207–8.
Mazeto IFS, Brommonschenkel CC, Miola AC, Ramos PM, Dos Santos DC, Miot HA. Ultrastructural evidence for anagen hair follicle infection with SARS‐CoV‐2 in early‐onset COVID‐19 effluvium. J Eur Acad Dermatology Venereol. 2022.
Bains P, Kaur S, Kaur K. Comparison of Dermoscopic Findings in Female Androgenetic Alopecia and Telogen Effluvium and Female Controls in a Tertiary Care Center. J Clin Aesthet Dermatol. 2022;15(5):29–34.
Rudnicka L, Olszewska M, Rakowska A. Atlas of trichoscopy: dermoscopy in hair and scalp disease. Springer Science & Business Media; 2012: 237-244 p.
Roda Â, Oliveira‐Soares R. Acute telogen effluvium in patients recently infected with SARS‐CoV‐2. J Port Soc Dermatol Venereol. 2021;79(1):21‐25.
Ye Q, Wang B, Mao J. The pathogenesis and treatment of the `Cytokine Storm’ in COVID-19. J Infect. 2020;80(6):607–13.
Watras MM, Patel JP, Arya R. Traditional Anticoagulants and Hair Loss: A Role for Direct Oral Anticoagulants? A Review of the Literature. Drugs - Real World Outcomes. 2016; 3(1):1–6.
