9 Cases of Alopecia Areata after the COVID vaccine

9 More Cases of Alopecia Areata After COVID 19 Vaccines

In past studies, vaccines have been implicated as one of the many triggers of autoimmune disease in individuals who carry an underlying genetic predisposition. An antibody-mediated response prompted by vaccination may cross-react with self-antigen, leading to autoimmunity.

The potential link between vaccines and the autoimmune disease alopecia areata is not a new finding. There have been several reports in the published medical literature of alopecia areata developing after not only COVID vaccines (Astraszena, ChAdOx1 and mRNA vaccines) but also after toxoid, herpes zoster virus, influenza Clostridium tetani, and human papillomavirus, influenza, hepatitis B and Japanese encephalitis.

Scollan et al, 2022

In a new study, Scollan and colleagues report 9 cases of alopecia areata happening soon after SARS-CoV-2 vaccination. 6 of the patients received the Pfizer mRNA vaccine and 3 had the Moderna mRNA vaccine. 3 of the 9 patients had a prior history of AA. Overall though, 6 of 9 had some autoimmune disease including 3 AA, and 3 thyroid and 1 joint disease.

Timing of the alopecia areata after vaccination was variable. In 2 patients, alopecia areata occurred 1-2 weeks after first dose and in 7 patients it occurred 1 week to 4 months after second dose.

Degree of hair loss was variable. 4 patients had patchy AA. 2 had widespread AA. 1 had alopecia totalis and 2 had alopecia universalis. It was of note that the 2 patients who developed alopecia universalis had a prior history of alopecia areata.

Treatment in this study was mainly with steroid injections and tofacitinib. 2 patients were treated with steroid injections. 2 patients were treated with tofacitinib 5 mg twice daily and 4 were treated with tofacitinib 10 mg twice daily. In the 9th patient, treatment was pending

Conclusion

There are now well over a handful of reports in the published medical literature of alopecia areata developing after receipt of a COVID vaccine. The authors pointed out in their report that to date the Centers for Disease Control and Prevention Vaccine Adverse Event Reporting System has catalogued almost 1000 cases of alopecia with the Pfizer and Moderna vaccines.

The exact incidence of COVID vaccine induced alopecia areata is not clear, nor are the exact mechanisms. It does appear that underlying immune dysregulation is a potential risk factor. However, it does appear that significant hair loss can occur in some affected patients.

REFERENCE

Scollan M et al. Alopecia areata after SARS-CoV-2 vaccination JAAD Case Rep. 2022 Feb;20:1-5.

Simakou T et al. Alopecia areata: a multifactorial autoimmune condition. J Autoimmun 2019; 98: 74–

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Wraith DC, Goldman M, Lambert PH. vaccination and autoimmune disease: what is the evidence? Lancet 2003; 362: 1659–1666.