Updated: Feb 1
Telogen effluvium: a sequela of COVID‐19
Karolina Mieczkowska, BS, 1 Alana Deutsch, BA, 1 Jenna Borok, MD, MAS, 1 Anthony K. Guzman, MD, 1 Renee Fruchter, MD, 1 Parth Patel, MD, 1 Olivia Wind, MD, 1 Beth N. McLellan, MD, 1 , 2 Ranon E. Mann, MD, 1 and Caroline P. Halverstam, MD 1 , 2
Since the emergence of the novel coronavirus SARS‐CoV‐2, the cause of COVID‐19, heavy attention has been paid to its life‐threatening pulmonary and cardiovascular manifestations. 1 However, cutaneous signs and symptoms of disease have also been described and may significantly impact patients. 2 While preliminary characterizations have aptly set expectations for acute disease course, it is imperative to establish similar familiarity with late‐course and postinfectious manifestations to guide appropriate treatment and patient education. Our patient population located in New York City, which was an early epicenter of disease, demonstrates elements of virus‐induced late sequelae. In the ambulatory dermatology clinic, one such increasingly apparent manifestation has been new onset diffuse hair loss in patients previously infected with SARS‐CoV‐2, clinically compatible with telogen effluvium (TE). TE is characterized by diffuse hair loss within months of a significant systemic stressor because of premature follicular transition from the anagen (active growth phase) to the telogen (resting phase). The telogen phase lasts approximately 3 months, after which excessive hair loss ensues. 3
Herein, we present 10 patients with concerns of increased hair loss following SARS‐CoV‐2 infection (Table 1). The patients are all female, with no history of hair loss, diverse ethnic backgrounds, and a median age of 55. All patients had laboratory confirmed COVID‐19, six reported mild symptoms, and four presented with severe disease requiring hospitalization. They all experienced excessive hair loss within weeks to months after infection, which included hair coming out in large clumps and thinning along the frontal hairline. While limited physical exam was available for the patients seen by telemedicine, overall exams revealed noncicatricial loss of hair volume, pronounced thinning, and positive hair‐pull test (Table 2). Besides COVID‐19, the patients did not report any new medical conditions, medications, or lifestyle modifications. While some females did have other risk factors for hair loss, these were chronic issues that would not explain the acute onset of their symptoms. Although additional patients presented with a similar complaint following previous COVID‐19‐like symptoms, they were not included because of lack of confirmatory PCR or antibody testing.
Given the lack of signs and symptoms of other causes of hair loss, such as an autoimmune disorder, vitamin deficiency, or hormonal abnormality, coupled with the fact that all of the patients recently recovered from COVID‐19, the patients were diagnosed with TE. 4 Fortunately, TE is a self‐limiting condition. Proper reassurance and education, however, is essential 3 and highlights the vital role that telemedicine has played over the past months in maintaining high‐level dermatologic care for our vulnerable population. 5 While intuitive that this phenomenon of TE secondary to COVID‐19 exists, as it has been similarly reported in recent scientific literature and lay media, it nonetheless remains imperative to increase awareness as to its possibility. With increasing numbers of recovering patients, the risk of developing this physically and emotionally distressing dermatologic manifestation will likely continue. 5 , 6
1. Bandyopadhyay D, Akhtar T, Hajra A, et al COVID‐19 pandemic: cardiovascular complications and future implications. Am J Cardiovasc Drugs 2020; 20: 311–324. [PMC free article] [PubMed] [Google Scholar] 2. Marraha F, Al Faker I, Gallouj S. A review of the dermatological manifestations of coronavirus disease 2019 (COVID‐19). Dermatol Res Pract 2020; 2020: 9360476. [PMC free article] [PubMed] [Google Scholar] 3. Asghar F, Shamim N, Farooque U, et al Telogen effluvium: a review of the literature. Cureus 2020; 12: e8320. [PMC free article] [PubMed] [Google Scholar] 4. Fabbrocini G, Cantelli M, Masara A, et al Female pattern hair loss: a clinical, pathophysiologic, and therapeutic review. Int J Womens Dermatol 2018; 4: 203–211. [PMC free article] [PubMed] [Google Scholar] 5. Rivetti N, Barruscotti S. Management of telogen effluvium during the COVID‐19 emergency: psychological implications. Dermatol Ther 2020: e13648 10.1111/dth.13648 [PMC free article] [PubMed] [CrossRef] [Google Scholar] 6. Turkmen D, Altunisik N, Sener S, et al Evaluation of the effects of COVID‐19 pandemic on hair diseases through a web‐based questionnaire. Dermatol Ther 2020: e13923 10.1111/dth.13923 [PMC free article] [PubMed] [CrossRef] [Google Scholar]