Alopecia Areata and COVID -19 : Does the stress of the pandemic increase the risk of AA?

Data Still Not Clear if Pandemic Stress Increases AA Risk

There has been much discussion lately about the stress of the current COVID 19 pandemic causing telogen effluvium. What about the risk of other hair loss conditions - such as alopecia areata?

The short answer is we don’t know yet. One study from a dermatology department in Turkey suggested cases of alopecia areata were increasing two months after the COVID-19 outbreak. Specifically, the researchers investigated the percentage of patients with alopecia areata in May 2020 and compared to the corresponding period of the previous year. They found that the percentage of alopecia areata was 1.48% after the COVID-19 pandemic, whereas it was 0.97% before the COVID-19 pandemic.

Does this mean that cases of alopecia areata are increasing with the pandemic? Well, no - at least not yet and at least not based on the study above. We need to keep in mind that main limitation of a study like this is there are no good controls. We need to keep in mind that during the pandemic, patients with more minor issues - like less severe chronic rashes, and those wanting routine skin examinations are going to stay home and only patients with severe disease are going to make their way into the dermatology clinic. This certainly can change the proportion of patients who appear to have any given disease.

For example, suppose for example that in 2019 that 5 people from the city of 5000 people came to clinic with alopecia areata and 95 came for other reasons. That means that 5 out of 100 total patients at the clinic had alopecia areata or 5 %. Suppose during the pandemic that 5 people from the city came to clinic with alopecia areata and 45 came for other reasons. This means that 10 % came for a diagnosis of alopecia areata. Can we conclude that the clinic is seeing more patients with alopecia areata? Yes. Can we conclude that the entire city has more cases of alopecia areata? No. There was 5 before and there are 5 now. The number affected with alopecia areata is the same.

Summary and Conclusion

It’s quite possible that there will be a slight increase in alopecia areata as a result of the stress of the pandemic (and theoretically even COVID 19 itself) - but the right type of studies will ultimately be needed to prove this. We need to get a sense of the number of affected patients in a given population rather than a given clinic to truly answer this questions. These are tougher studies to do - but these are the studies that are needed to allow us to evaluate diseases prevalence.

Reference

Kutlu O.  Short-term stress-related increasing cases of alopecia areata during the COVID-19 pandemic. Journal of Deramtological Treatment 2020