INTRODUCTION
Novel coronavirus SARS-CoV-2, designated as COVID-19 by the World Health Organization (WHO) on February 11, 2020, is one of the highly pathogenic β-coronaviruses that infects humans.1 Alopecia areata (AA) is a chronic inflammatory disease with sudden hair loss.2,3 There is strong evidence that AA is a tissue-specific autoimmune disease that develops based on genetic predisposition.4 In several patients, acute or chronic psycho-emotional stress may be causing the initiation and/or progress of AA.5 It is suggested that psychological stress can trigger or exacerbate inflammatory skin diseases through the neuroendocrine system, which is an essential connection between the brain and the skin.6,7 Hair loss has emerged as a frequently noted side effect of infection with COVID-19, and has been observed in many patients who have recovered from a documented COVID-19 illness.8,9
We report a case of COVID-19 associated hair loss. We aim to highlight the need for clearer investigation and follow-up guidelines for stress-related autoimmune diseases correlating with the COVID-19 outbreak.7
We report a case of COVID-19 associated hair loss. We aim to highlight the need for clearer investigation and follow-up guidelines for stress-related autoimmune diseases correlating with the COVID-19 outbreak.7
CASE
Our patient was an otherwise healthy 28-year-old man with no history of hair loss prior to testing positive for COVID-19.
Our patient presented to our practice with patchy hair loss 2 months post initial COVID-19 infection. The patient reported that hair loss had been progressively worsening since testing positive for COVID-19. Consent for photography and biopsy was obtained. Histological examination of the sample collected from the scalp was consistent with AA. The patient was treated with 10 mg/mL of intralesional Kenalog injections, 1 cc total injected bi-weekly for 2 months.
The literature reports a clinical response as early as 6 to 8 weeks from the initiation of treatment, which results in the growth of new hairs in many patients.10 However, despite treatment with Kenalog, our patient's AA continued to progress. The patient elected to discontinue treatment with intralesional Kenalog and shaved his head to minimize the visual appearance of his hair loss (Figure 3). Twelve months post initial presentation, the patient was seen for an annual Total Body Skin Exam. He presented with complete hair regrowth. He reported that his hair stopped falling out 6 months after he was first diagnosed with COVID-19 and had completely regrown since then (Figures 4 and 5).
Our patient presented to our practice with patchy hair loss 2 months post initial COVID-19 infection. The patient reported that hair loss had been progressively worsening since testing positive for COVID-19. Consent for photography and biopsy was obtained. Histological examination of the sample collected from the scalp was consistent with AA. The patient was treated with 10 mg/mL of intralesional Kenalog injections, 1 cc total injected bi-weekly for 2 months.
The literature reports a clinical response as early as 6 to 8 weeks from the initiation of treatment, which results in the growth of new hairs in many patients.10 However, despite treatment with Kenalog, our patient's AA continued to progress. The patient elected to discontinue treatment with intralesional Kenalog and shaved his head to minimize the visual appearance of his hair loss (Figure 3). Twelve months post initial presentation, the patient was seen for an annual Total Body Skin Exam. He presented with complete hair regrowth. He reported that his hair stopped falling out 6 months after he was first diagnosed with COVID-19 and had completely regrown since then (Figures 4 and 5).
