COVID VACCINES AND COVID INFECTION BOTH TRIGGER ALOPECIA AREATA

It’s becoming clear that COVID VACCINES and COVID INFECTION can both potentially TRIGGER alopecia areata. Add to this one more finding - COVID VACCINES in some cases can PREVENT alopecia areata. 

Wow, what complexity!

It's becoming increasingly clear that a variety of mechanisms need to enter the mind when seeing a patient with alopecia areata.  Alopecia areata was a fairly common autoimmune condition before the pandemic so clearly patients are still developing alopecia areata for the same reasons they always developed alopecia areata. 

Genetic and Environmental Factors Play a Role in Alopecia Areata

We know that genetic factors and environmental factors play a key role in the development of alopecia areata. In fact, about 70 % of alopecia areata is explained by genetic factors and 30 % is probably due to the environment that the person lives in. Stress, infections, smoking, obesity and a wide variety of other factors are thought to be potential  trigger alopecia areata. 

But we now need to add COVID infection and COVID vaccines to the list of triggers. The list of contributing factors is growing pretty long and clearly all the factors aren't worked out. 

What Recommendations Should we be Making?

There are a group of people out there in the world that are going to develop alopecia areata if they get COVID infection and there are a group of people out there in the world that are probably going to develop alopecia areata from getting COVID vaccines and there are a group of people out there in the world that are going to reduce their chance of developing alopecia areata by getting a COVID vaccine. 

We don't yet know which is which and what recommendations to make! Recommending a vaccine to some will help reduce their chances of developing alopecia areata! Recommending a vaccine to others will increase their chances of developing alopecia areata! 

Universal recommendations and universal templates rarely work well in the field of medicine as we have spoken about many times before. Clearly vaccines are needed. The decision on getting or not getting a vaccine is far more complex than the risk of developing alopecia areata and other factors need to be discussed on a case by case basis with one's doctor. Here, we are talking specifically about the risk of alopecia areata. 

The story of hair loss is never quite as simple as one would think !

References

Wang C-W et al. Clinical characteristics and immune profiles of patients with immune-mediated alopecia associated with COVID-19 vaccinations. Clin Immunol. 2023 Oct:255:109737. 

Pastukhova E et al. Alopecia Areata as a Sequela of COVID-19 Vaccination: A Systematic Review J Cutan Med Surg. 2023 Jan-Feb;27(1):64-65.   

Genco L et al. Alopecia Areata after COVID-19 Vaccines. Skin Appendage Disord. 2023 Mar;9(2):141-143.