Early Onset Shedding After COVID 19 - Is this an Anagen Effluivum?

New Data Points to Different Mechanisms of Hair Loss After COVID 19

Hair loss can occur after COVID 19 infection, with estimates suggesting that 20-50 % or more of patients may be affected by shedding. It is becoming increasing clear that there are an array of different clinical hair loss presentations and not all patients have the same story. In particular, some patients have hair loss occurring within a few weeks of the COVID 19 infection and some have hair loss occurring 2-3 months later.

Shanshal M. 2022

Shansal described a 35 year old woman who was admitted with COVID 19. She developed a urticarial rash and hair loss 10 days after admission. The author propsed the hair loss pattern was that of an anagen effluvium although a precise description of the hairs was not given in the report.

Miola et al. 2022

Authors from Brazil set out to evaluate clinical presentation of 203 hospitalized patients with confirmed COVID-19. Of the 203 patients, 5.4% (11 patients) reported hair loss with onset early during hospitalization, (less than 30 days after the infection).

Seven of them were assessed using trichoscopy, a trichogram, and a histologic evaluation. All the patients presented a positive pull test result.

TRICHOSCOPY DATA

Trichoscopy did not reveal broken hairs, anisotrichosis, or yellow dots, but it did reveal some empty follicles.

TRICHOGRAM DATA

The trichogram obtained from the vertex revealed more than 10% dystrophic anagen hairs and more than 20% telogen hairs in all the cases.

BIOPSY DATA

Histologically, there was predominance of anagen terminal follicles, no relevant miniaturization >10%), and no cases showing >25% telogen follicles. The authors did not find significant inflammation.

Conclusion and Discussion

This is a really nice study which reminds us that post COVID shedding is probably a bit more complex than we give credit to. Some patients have a traditional type of shedding which happens around 2-3 months after infection. This is a telogen effluvium. Some patients have early shedding which happens with 2-4 weeks. This is likely to be an dystrophic anagen effluvium.

The authors do not set out to explain who is at risk for dystrophic anagen effluvium as this is not the purpose of the study. The authors propose that a variety of mechanisms may lead to this type of hair loss.

REFERENCE

Anna Carolina Miola et al. Early-onset effluvium secondary to COVID-19: Clinical and histologic characterization. J Am Acad Dermatol. 2022 May;86(5):e207-e208.

Shanshal M. COVID-19 related anagen effluvium. J Dermatolog Treat. 2022 Mar;33(2):1114-1115.