Abstract
Objective: To characterize and summarize clinical and demographic features in patients with post-COVID 19 Telogen Effluvium and compare with those reported in the literature. Design: A observational study of 10 patients who reported symptoms of Telogen Effluvium following COVID-19 symptoms. Medical history, physical exam and any relevant lab findings were conducted during an initial visit and patients were re-evaluated after 14 weeks. Setting: Patients presented to an outpatient dermatology clinic affiliated with a large, urban academic center New York City from May to August 2020, approximately 3 months after a surge in COVID-19 cases. Participants: Adult patients who were diagnosed with Telogen Effluvium and had laboratory evidence of previous COVID-19 infection who were seen in person or through telehealth virtual visits were consented for this study. Exposures: All participants had laboratory evidence and clinical symptoms consistent with previous COVID-19 symptoms. Main Outcomes and Measures: We collected data from 10 participants and measured average onset of TE from initial COVID-19 symptoms, medical intervention for COVID-19 infection, physical exam findings, and whether or not patient experienced resolution of TE symptoms after 14 weeks. We performed a literature review using the terms “telogen effluvium”, “covid” and “hair” and investigation was limited to adult case reports and cohort studies appearing in the English-Language literature as of March 2021. Clinical and demographic findings were analyzed and compared with those of our patient cohort. Results: Nine out of ten patients in our cohort had mild COVID-19 symptoms only with mean onset of hair shedding was 73 days following infection. None had previous history of hair loss. By contrast, of the 28 patients identified in the literature review 50% of these patients were hospitalized for severe COVID-19 infection with average onset of TE 87 day after infection. 12% of these patients had pre-existing androgenic alopecia. Conclusions and Relevance: Telogen Effluvium is a distressing, yet self-limited condition that can occur following both mild and severe COVID-19 infection. Dermatologists should expect an increase in TE in areas heavily affected by COVID-19 and reassure patients of the likely cause and that symptoms will resolve over time.
Highlights
Telogen Effluvium (TE) is a non-scarring alopecia characterized by diffuse hair shedding that has recently been reported as a post-infectious manifestation of the novel coronavirus SARS-CoV-2.1 In response to physiological or psychological stress, premature termination of the anagen phase and subsequent transition to the telogen phase of hair growth result in shedding of hair follicles 2-3 months after the precipitating event
We describe ten cases of a telogen effluvium following COVID-19 infection from an ambulatory dermatology clinic in New York City, an early epicenter of the pandemic and review the current literature
We report 10 patients who developed acute, new onset TE weeks after COVID-19 infection
Summary
Telogen Effluvium (TE) is a non-scarring alopecia characterized by diffuse hair shedding that has recently been reported as a post-infectious manifestation of the novel coronavirus SARS-CoV-2.1 In response to physiological or psychological stress, premature termination of the anagen phase and subsequent transition to the telogen phase of hair growth result in shedding of hair follicles 2-3 months after the precipitating event. The condition is usually self-limited, with acute cases resolving within 6 months of onset.[2] It has been proposed that proinflammatory cytokines, impaired anti-coagulation and severe psychosocial stress of COVID-19 triggers TE in survivors recovering from the disease.[3] We describe ten cases of a telogen effluvium following COVID-19 infection from an ambulatory dermatology clinic in New York City, an early epicenter of the pandemic and review the current literature. We characterized and summarized clinical and demographic features in patients with post-COVID 19 Telogen Effluvium and compared it with those reported in the literature
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