INTRODUCTION
COVID-19 has been linked to several post-viral dermatologic sequelae, most notably telogen effluvium (TE). However, emerging evidence suggests that SARS-CoV-2 may also trigger autoimmune-mediated hair loss, including alopecia areata (AA) and its most severe form, alopecia universalis (AU).1,2,3 Unlike TE, which is transient and non-inflammatory, AU is characterized by auto-immune T-cell infiltration targeting hair follicles, leading to loss of immune privilege.2,3 Histopathologic studies of AU have demonstrated peribulbar lymphocytic infiltration, supporting the role of immune dysregulation in follicular destruction.3 Given COVID-19's association with an elevated IFN-γ response, its role in triggering AU warrants further investigation.4,5
Recent studies suggest that SARS-CoV-2 may act as a viral trigger for AU via IFN-γ-driven immune dysregulation. The virus-induced prolonged inflammatory response may cause dysregulated immune privilege of hair follicles, potentially resulting in AU onset or exacerbation.5,6,7 Additionally, AU cases have been reported following both COVID-19 infection and vaccination, suggesting that immune hyperactivation may be a key pathogenic factor.6,8
Although idiopathic AU is chronic and relapsing, post-COVID-19 AU may follow a distinct course due to persistent post-viral immune activation.4,9 Given the increasing reports of post-COVID-19 AU, understanding its unique disease course and long-term management is critical. Here, we present a case of post-COVID-19 AU with relapse after treatment discontinuation, reinforcing the need for continued investigation into optimal treatment strategies.
Case Report
A 79-year-old woman with a history of hypothyroidism and thrombocytopenia (both stable and well-controlled) developed sudden, extensive, non-scarring hair loss one month after recovering from COVID-19 in January 2023. She had no personal or family history of hair loss. By February 2023, she exhibited total scalp and body hair loss (Figure 1A), consistent with AU. Given the temporal association with COVID-19 and the absence of other known triggers, post-COVID-19 immune dysregulation was suspected as the underlying mechanism.4,9
Recent studies suggest that SARS-CoV-2 may act as a viral trigger for AU via IFN-γ-driven immune dysregulation. The virus-induced prolonged inflammatory response may cause dysregulated immune privilege of hair follicles, potentially resulting in AU onset or exacerbation.5,6,7 Additionally, AU cases have been reported following both COVID-19 infection and vaccination, suggesting that immune hyperactivation may be a key pathogenic factor.6,8
Although idiopathic AU is chronic and relapsing, post-COVID-19 AU may follow a distinct course due to persistent post-viral immune activation.4,9 Given the increasing reports of post-COVID-19 AU, understanding its unique disease course and long-term management is critical. Here, we present a case of post-COVID-19 AU with relapse after treatment discontinuation, reinforcing the need for continued investigation into optimal treatment strategies.
Case Report
A 79-year-old woman with a history of hypothyroidism and thrombocytopenia (both stable and well-controlled) developed sudden, extensive, non-scarring hair loss one month after recovering from COVID-19 in January 2023. She had no personal or family history of hair loss. By February 2023, she exhibited total scalp and body hair loss (Figure 1A), consistent with AU. Given the temporal association with COVID-19 and the absence of other known triggers, post-COVID-19 immune dysregulation was suspected as the underlying mechanism.4,9
