Alopecia and COVID-19

On October 17, 2019, the first case of COVID-19 was recorded. And this year has changed the life of all mankind irreversibly. When the first wave of infection started in Canada, few people thought about hair. People lived in fear and panic for themselves, their loved ones, suffered from isolation.

The first patients began to turn to trichologists in July 2020, when the struggle with the main complications and consequences ended. Hospitalization for months, a huge amount of drugs, the death of loved ones. Therefore, reactive alopecia were expected. But it was impossible to imagine the scale of the tragedy then.

Patient complaints

Already by the first phrases of our patients, you can understand the root cause: “hair loss”, “how much I spend on my hair, so much remains in my hands”, “everything is in my hair at home”, “every time I comb a full sink of hair” — and so on.

Patients, as a rule, are psychologically labile. Extremely depressive state, tearfulness and neurosis are frequent companions of the problem. Psychiatrists have yet to study the neurotoxicity of the virus, but cases of even acute psychoses have been described.

Alopecia and COVID-19 — what is known at the moment?

Of course, there were post-infectious alopecia before COVID-19. Hair loss after infectious diseases is traditionally classified as telogen alopecia (telogen effluvium, TE). The hair follicle can react to the infectious process with either anagen hair loss with an early onset, or telogen with a late onset. Traditionally, 2-3 months pass from the moment of pathological exposure to the development of alopecia. But in the case of post-ovoid alopecia, everything happens in the fastest way: 4-5 weeks is enough for massive hair loss.

At the moment, several reports have been published on clinical cases of dystrophic anagen and telogen alopecia associated with COVID-19, however, confirmation of the diagnosis based on a trichogram was obtained only for TE. In general, hair loss may be caused by a multisystem inflammatory process with a febrile rise in temperature, which is characteristic of COVID-19. Objective confirmation of an inflammatory reaction at the level of the hair follicle or a direct infectious lesion of the follicle in severe acute respiratory syndrome caused by coronavirus type 2 (SARS-CoV-2) has not yet been obtained.

Telogen effluvium is one of the most common forms of alopecia in women, covering less than 50% of hair. In most cases, its pathomechanism is characterized by an abnormal shift of the follicular cycle with diffuse synchronization of hair follicles in the telogen phase, leading to an overall increase in the number of hair follicles predisposed to loss. Endocrine diseases, stress, pregnancy and childbirth, injuries, nutritional deficiencies and feverish conditions can serve as trigger factors for telogen alopecia

Chinese scientists assessed the nature of the clinical consequences of COVID-19. The study involved 538 patients (54.5% — women, 45.5% — men) discharged from the Renmin Hospital of Wuhan University (Wuhan, China) after suffering COVID-19. The average age of patients was 52 years. Alopecia was a characteristic clinical consequence of COVID-19, diagnosed in 154 people (12 men and 142 women), which accounted for 28.6% of the total number of participants. Of these, 112 patients reported baldness that began after discharge from the hospital, and 42 — during hospitalization. The authors noted a pronounced predominance of alopecia among women: the frequency of TE in this subgroup of patients was 48.5%.

Trüeb R.M. et al. We analyzed 10 cases of TE after COVID-19 and noted that severe forms of the disease were associated with earlier and pronounced hair loss. According to the results obtained by the authors, complete restoration of hair growth occurred after 3-6 months.

However, the accumulated experience of observing patients with alopecia after COVID-19 suggests that TE is not observed in all cases. With a tendency to androgenetic forms, there is a rapid transition from the 1st degree of severity of alopecia to the final degrees. Also, as a consequence of COVID-19, cases of nest and scar alopecia have been recorded.

Diagnosis and therapy of postcovid alopecia

Anamnesis collection, a sharply positive pull test and an increased amount of hair in the telogen stage on the phototrichogram (more than 50%) allow us to assume the presence of postcovid alopecia. In addition, since postcovid alopecia is close to GA, immunological diagnostics comes to the fore in patients who have been infected with SARS-CoV-2:

  • leukocyte formula, lymphocyte subpopulations: CD3, CD4, CD8, CD19, CD25, CD56;
  • Immunoglobulin A, M, G, HCT test;
  • SRB;
  • D-dimers;
  • LDH (in pneumonia is prognostic above 600);
  • ferritin;
  • IL-6.

It is pointless to engage in the analysis of deficit states in the acute period.

Since the approach to the management of patient data is formed by trial and error, it is impossible to talk about approved algorithms. The long-term results of therapy were also not evaluated.

Nevertheless, based on the available experience, it can be concluded that the treatment regimens of autoimmune forms of alopecia work quite quickly and effectively in cases of acute phase of postcovid alopecia.

Conclusion

Against the background of life-threatening conditions resulting from COVID-19, alopecia fades into the background, but during the rehabilitation period, the issue of quality of life becomes relevant again, and it is no longer possible to ignore the problem of hair loss. It is important not only to stop hair loss, but also to ensure their normal recovery. This requires a specialist to take a comprehensive approach to solving the problem using care products, propecia or a similar drug so that the treatment process begins in the doctor’s office and continues in the patient’s daily life.