Alopecia Areata within 1 Week of the Pfizer Vaccine

Alopecia Areata After COVID Vaccination in a Man without History

There are emerging reports of alopecia areata following COVID vaccination. Lee and colleagues share a report of an 80 year old male with no history of alopecia areata who developed alopecia areata within 1 week of his vaccine. The authors felt this was significant to share given that up to this point in time, the four reported cases of AA arising after the COVID-19 vaccination occurred in patients with a previous histories of AA.

Lee et al, 2022

Authors from Italy reported the case of an 80-year-old man who developed rapidly progressive facial hair loss 7 days after the administration of the first dose of the Pfizer/BNT162b2 vaccine. He had no personal or family history of alopecia or autoimmunity of any kind. His hair loss did not improve after using of topical application of clobetasol foam. The patient proceeded to develop a progressive worsening of the condition after the second dose of the vaccine. At the 2-month time point, he had progressed to alopecia totalis. He then initiated treatment with topical immunotherapy with (squaric acid dibutylester) but this did not help.

Conclusion

There are several emerging reports of an association between COVID 19 vaccination (and infection) and rapid onset alopecia areata. These reports don’t prove it but certainly suggest it. It’s not clear why this occurs but likely the vaccine triggers immune activation in those with some susceptibility. It has been prosed that the vaccine might prompt an antibody-mediated response that may cross-react with self-antigen, leading to autoimmunity. The risk factors are not clear.

Reference

Lee MM. Alopecia areata following COVID-19 vaccination: vaccine-induced autoimmunity? Int J Dermatol. 2022 Feb

Rossi A, Magri F, Michelini S, et al. recurrence of alopecia areata after covid-19 vaccination: a report of three cases in Italy. J Cosmet Dermatol 2021; 20: 3753–3757. S

Essam R, Ehab R, Al-Razzaz R, et al. alopecia areata after ChAdOx1 nCoV-19 vaccine (Oxford/AstraZeneca): a potential triggering factor? J Cosmet Dermatol 2021; 20: 3727–3729.