Post COVID Shedding: Does the severity of infection impact severity of shedding?

Severity of COVID Pneumonia Impacts Chance of Hair Shedding.

Authors from Italy set out to evaluate whether the severity of COVID pneumonia impacts the severity of telogen effluvium.

To do so they evaluated outcomes of 104 patients who recovered from COVID-19 pneumonia recovery; 80 (77%) had been hospitalized in an Intensive Care Unit and the remaining ones had been treated at home. The extent of TE was assessed with a visual analogic scale for thick bundle of hairs.

Thirty-two patients reported a history of TE and their mean TE-VAS score was 5.78 on a scale of 9 (range 3–9). Women had about a 5-fold higher risk (odds) of having of TE compared to males (OR = 4.69, 95%CI: 1.91, 11.49; p = .001), and the association became even stronger when adjusted for COVID-19 severity (hospital admission vs home care: OR = 6.09, 95%CI: 2.34, 15.88; p < .001) and use of methylprednisolone, enoxaparin, and/or hydroxychloroquine. (OR=15.77 (2.77, 300.75, p=0.011)

Interestingly, levels of an inflammatory marker known as IL-1β correlated with severity of shedding. IL-1β is a member of the IL -1 family and plays a role in immune system activation. Interestingly, IL-1 is also an inhibitor of hair growth in vitro. Levels of IL-1β > 5 ng/l (ORadj 4.72, 95%CI: 1.31, 23.19, p = .03) were associated with TE. This was a weak link.

Conclusion and Summary

This study supports a notion that the severity of TE may be closely linked to the severity of the COVID 19 infection. This was a pretty small study overall and we don’t have enough data to really show that levels of IL-1β trend with the degree of shedding the patient experiences. The authors only analyzed data according to shedding or no shedding and did not have enough patients to really analyze according to degree of shedding. Of all the factors the authors looked at including CRP, other Interleukins, immunoglobulins and other inflammatory markers only IL-1β had any kind of an association. With a link at 0.03 in a study this size it’s really had to know it’s role. It’s interesting, nevertheless, and further studies will hopefully clarify this.

This is one of the few studies which shows a clear link between severity of hair loss and severity of COVID 19.

REFERENCE

Guarnieri G et al. Relationship between hair shedding and systemic inflammation in COVID-19 pneumonia. Ann Med. . 2022 Dec;54(1):869-874.

Hoffmann R, Eicheler W, Wenzel E, et al. Interleukin- 1beta-induced inhibition of hair growth in vitro is mediated by cyclic AMP. J Invest Dermatol. 1997; 108(1):40–42.