Public Attitudes, Awareness and Fears Related to the Spread of COVID-19 in Bulgaria

The pandemic caused by COVID-19 has led to radical lifestyle changes worldwide, particularly in the Republic of Bulgaria, and was a factor for global changes in economics, politics, healthcare and daily life. Aim(s): The aim of the study was to analyze the public attitudes, awareness and fears related to the COVID-19 disease in the Republic of Bulgaria. Material(s) and Method(s): The survey was conducted between August 1st, 2022 and September 1st, 2022 via an anonymous questionnaire consisting of 24 closed questions. A total of 1861 people, aged 18-69 years and older, took part in the survey after being selected randomly. The data were statistically processed via MS Excel. Result(s): The main source of information to the respondents on issues related to COVID-19 was the Internet (29,8%), followed by TV (26%) and the specialized website (Single information portal) - 15,9%. More than one-third (35,1%) of the respondents was afraid of getting infected and an equal share of participants reported that they have been infected with COVID-19. More than half of the respondents (52,5%) adhered to all the provisions of the governmental bodies related to limiting the COVID-19 pandemic. The most frequent symptom of post- COVID-19 syndrome was being easily fatigued (26,7%), followed by shortness of breath (13,4%) and persistent cough (11,6%). Conclusion(s): The survey could be useful in understanding what were the public attitudes, awareness and fears related to the COVID-19 disease in the Republic of Bulgaria during the pandemic.Copyright © 2023 D. Penchev et al., published by Sciendo.

Ritlecitinib is effective for alopecia areata in patients 12 years and older

Ritlecitinib (Pfizer Inc) demonstrated efficacy in treating alopecia areata in patients aged 12 years and older with at least 50% scalp hair loss, according to results from a phase 2b/3 trial (NCT03732807) published in The Lancet. Of those randomly assigned, 104 patients discontinued treatment: 34 withdrew, 19 had adverse events (AEs), 12 were physician decided, 12 were discontinued due to lack of efficacy, 13 were lost to follow-up, 5 were moved to long-term study transfer, 4 discontinued due to pregnancies, 2 discontinued for protocol deviations, 1 declined follow-up due to COVID-19, 1 attended the last visit late due to COVID-19, and 1 was nonadherent. Between the placebo and the ritlecitinib 200 mg plus 50 mg group, the difference in response rate based on a SALT score of 20 or less was 29.1% (95% CI, 21.2-37.9;P < .0001). The difference in response rate based on a SALT score of 20 or less between placebo and ritlecitinib was 20.8% (95% CI, 13.7-29.2;P < .0001) for the 200 mg plus 30 mg group, 21.9% (95% CI, 14.7-30.2;P < .0001) for the 50 mg group, and 12.8% (95% CI, 6.7-20.4;P = .0002) for the 30 mg group.

Morbidity and Mortality Outcomes for Patients with Moderate-to-Severe Covid-19 Diseases: A Post-Hospitalization Follow-up Study

Intro: The burden of post-COVID-related morbidity and mortality is significant yet undermined. We studied the morbidity and mortality outcomes of COVID-19 patients with moderate-to-severe diseases by 90-day post-hospitalization. Method(s): This retrospective cohort study included 510 COVID-19 patients admitted to Kepala Batas Hospital with moderate to severe diseases, requiring oxygen therapy during hospitalization (Malaysia COVID severity category >=5;WHO scale >=5), between January and August 2021. We conducted telephone surveillance for 90 days post-discharge from the hospital, assessing for post- COVID complications and mortality. Relevant clinical data were extracted from medical records. Multiple logistic regression was employed to examine factors associated with post-COVID mortality after index hospitalization. Finding(s): Among 510 patients, 51%(n=260) were male with a mean age of 52.1 (14.65) years. A third had hypertension (39.8%) and diabetes (31.4%). Only 15.5% were partially vaccinated and 4.9% had complete vaccination before hospitalization. Nearly 65% were supplemented with nasal prong or face mask oxygenation (<10L/ min), 25.7% received high flow oxygenation and 10% were mechanically ventilated. Approximately 23.3% (n=119) of patients were admitted to the intensive care unit. By 90-day post-hospitalization, 46% (n=203) reported residual symptoms: lethargy (14.5%), dyspnoea (12.2%), hair loss (7.5%), memory loss (6.3%), depression (3.9%), anxiety (2.7%) and 1.6% required home oxygen supplementation. Forty-four patients (8.5%) were re- hospitalized at least once, with 40.9% due to post-COVID complications. About 87% of patients attended their post-COVID clinic appointment. Nearly 13.5% (n=69) of patients died within 90 days after being discharged from the hospital. Adjusted for gender, comorbids and ventilatory status, age >=60 years (aOR 7.96;95%CI 3.75-16.92;p<0.001), diabetes (aOR 2.30;95%CI 1.12-4.72;p=0.024) and high oxygen requirement (aOR 3.41;95%CI 1.56-7.46;p=0.002), were associated with increased 90-day post-COVID mortality. Conclusion(s): Post-COVID morbidity and mortality are significant among survivors hospitalized for moderate- to-sever disease. Comprehensive care must be addressed to improve the outcomes of post-COVID patients.Copyright © 2023

Recent Advances in Understanding of the Etiopathogenesis, Diagnosis, and Management of Hair Loss Diseases.

Hair-loss diseases comprise heterogenous conditions with respective pathophysiology and clinicopathological characteristics. Major breakthroughs in hair follicle biology and immunology have led to the elucidation of etiopathogenesis of non-scarring alopecia (e.g., alopecia areata, AA) and cicatricial alopecia (e.g., lichen planopilaris, LPP). High-throughput genetic analyses revealed molecular mechanism underlying the disease susceptibility of hair loss conditions, such as androgenetic alopecia (AGA) and female pattern hair loss (FPHL). Hair loss attracted public interest during the COVID-19 pandemic. The knowledge of hair loss diseases is robustly expanding and thus requires timely updates. In this review, the diagnostic and measurement methodologies applied to hair loss diseases are updated. Of note, novel criteria and classification/scoring systems published in the last decade are reviewed, highlighting their advantages over conventional ones. Emerging diagnostic techniques are itemized with clinical pearls enabling efficient utilization. Recent advances in understanding the etiopathogenesis and management for representative hair diseases, namely AGA, FPHL, AA, and major primary cicatricial alopecia, including LPP, are comprehensively summarized, focusing on causative factors, genetic predisposition, new disease entity, and novel therapeutic options. Lastly, the association between COVID-19 and hair loss is discussed to delineate telogen effluvium as the predominating pathomechanism accounting for this sequela.

The association of hair loss and coronavirus infection COVID-19 – facts and hypotheses

The main manifestations of COVID-19 are primarily interstitial pneumonia and respiratory failure. No less than 20% of patients have variable skin rashes, which try to be interpreted as markers and predictors of the peculiarities of the course of coronavirus infection. In addition, hair loss is a characteristic manifestation of COVID-19, and the salivary follicles are regarded as a target for SARS-CoV-2. The most common variants of alopecia in patients with a new coronavirus infection or vaccine-induced alopecia are acute telogenic, nondescript, and androgenetic alopecia. This review provides information on the most common variants of hair loss in patients with SARS-CoV-2 infection, the features of their manifestations, and possible mechanisms of development. Acute telogenic hair loss is the most common variant of SARS-CoV-2-induced alopecia, is characteristic of patients with subacute course of COVID-19 and can be combined with trichodynia, anosmia and aguvia, which are markers of nervous system damage. Given the variability in the time of onset after infection, a heterogeneous pathogenesis of alopecia can be assumed. Nested alo-pecia after COVID-19 is often a relapse of the disease, its severity and frequency do not correlate with the severity of the infectious disease, and its prevalence in women indicates the importance of hormonal factors in its development. Androgenetic alopecia may be a predictor of high risk of infection, severe course, and recurrence of COVID-19. The first two variants of alopecia may be associated with COVID-19 vaccination, and the latter is a predictor of inadequate immune response to vaccine administration. The mechanisms of the damaging effects of SARS-CoV-2 on hair follicles have not been fully deciphered and are most likely complex, with different leading links in different types of hair loss. Deciphering these mechanisms may provide prerequisites for understanding the mechanisms of COVID-19 damage to other tissues and organs. © Smirnova I.O. 2023.

Severe COVID-19 infection predisposes patients to greater burden of hair loss

There is a growing body of evidence suggesting a link between COVID-19 infection and certain forms of hair loss, such as telogen effluvium. The present study aims to determine the prevalence of hair loss following COVID-19 infection and ascertain the role of COVID-19 severity as a risk factor for its development. A retrospective study was conducted using patient data from the Northwestern Medicine Enterprise Data Warehouse with institutional review board approval from Northwestern University. Patients aged >= 18 years with COVID-19 diagnoses between January 2020-June 2022 and >= 1 encounter with dermatology providers within 180 days post-infection were included in the study. History of COVID-19 and documented hair loss diagnoses were recorded along with demographic data. COVID-19 severity was classified based on whether the patient was given outpatient or inpatient/emergency care for COVID-19. Time-to-alopecia onset was calculated relative to the nearest preceding COVID-19 diagnosis. Pearson's chi-squared and Kaplan-Meier analysis were performed to evaluate differences in incidence and time-to-alopecia onset by severity of COVID-19 infection. Analyses were conducted using R 4.2.1. In total, 10,861 patients met the inclusion criteria for the study. Patients were more commonly female (N = 6,974, 64.2%) and White (N = 8,301, 76.4%) with a mean age of 48 years at COVID-19 diagnosis. Overall, 6.5% of COVID-19 patients treated in inpatient/emergency settings developed hair loss compared to 4.7% in outpatient settings (P = 0.009). Patients with outpatient care had a median time to alopecia diagnosis of 73 days, compared to 99 days for patients with inpatient/emergency care (P = 0.019). Our findings demonstrate hair loss following COVID-19 infection as a notable sequela of infection. Clinicians should closely monitor patients following hospitalization for COVID-19, as they may be predisposed to hair loss following infection due to psychological or physiological stress. Future studies should aim to validate our findings and explore this relationship on a larger scale.Copyright © 2023

Decreased Gas6 and sAxl Plasma Levels Are Associated with Hair Loss in COVID-19 Survivors.

Post-acute conditions after coronavirus disease 2019 (COVID-19) are quite common, although the underlying pathogenetic mechanisms leading to these conditions are not yet completely understood. In this prospective observational study, we aimed to test the hypothesis that Growth Arrest-Specific 6 (Gas6) and its soluble receptors, Axl (sAxl) and MerTK (sMer), might be implicated. A total of 263 subjects underwent a structured clinical evaluation one year after their hospital discharge for COVID-19, and they consented to donate a blood sample to measure their circulating Gas6, sAxl, and sMer levels. A total of 98 (37.3%) post-COVID-19 subjects complained of at least one residual physical symptom one year after their hospital discharge. Univariate analysis revealed that sAxl was marginally associated with residual symptoms, but at the level of logistic regression analysis, only the diffusing capacity of the lungs for carbon monoxide (DLCO) (OR 0.98, CI 95%: 0.96-0.99; p = 0.007) and the female sex (OR 2.49, CI 95%: 1.45-4.28; p = 0.001) were independently associated with long-lasting symptoms. A total of 69 (26.2%) subjects had hair loss. At the level of univariate analysis, Gas6, sAxl, DLCO, and the female gender were associated with its development. In a logistic regression analysis model, Gas6 (OR 0.96, CI 95%: 0.92-0.99; p = 0.015) and sAxl (OR 0.98, CI 95%; 0.97-1.0; p = 0.014), along with the female sex (OR 6.58, CI 95%: 3.39-12.78; p = 0.0001), were independent predictors of hair loss. Decreased levels of Gas6 and sAxl were associated with a history of hair loss following COVID-19. This was resolved spontaneously in most patients, although 23.7% complained of persistent hair loss one year after hospital discharge.

Central cicatricial centrifugal alopecia or something else?

A 58-year-old African woman was referred for the management of scalp alopecia that had started in her thirties over the vertex of her scalp and had progressively involved > 90% of her scalp over the years. She was diagnosed with central centrifugal cicatricial alopecia of many years' duration and was being managed with annual wigs. On further questioning in the clinic, her chief complaint was a painful area over the vertex of the scalp, which had been affecting her sleep for years. She admitted to having used hair treatments in the past, after her hair loss had started. Clinical examination revealed a soft, tender, boggy swelling at the site of pain;however, the rest of her scalp felt like palpating cotton wool. Trichoscopic examination showed no remnant follicular openings, and histology showed end-stage alopecia. Her body mass index (BMI) was noted to be > 45 and there was an associated ichthyosiform rash on her shins bilaterally. Magnetic resonance imaging of her brain was requested for suspected lipoedematous scalp alopecia. Radiological findings led to a diagnosis by demonstrating 24-mm-thick subcutaneous adipose tissue - the highest recorded for this condition. Normal scalp thickness is suggested to be 6 mm. The patient declined a trial of intralesional steroids and topical Dermovate was unsuccessful. Lipoedematous scalp is a rare disease marked by a soft thickening of the scalp, first recorded in 1935 (Cornbleet T. Cutis verticis gyrata? Lipoma? Arch Dermatol Syphilol 1935;32: 688). A similar clinicopathological entity associated with nonscarring but permanent acquired alopecia was described in 1961 (Coskey RJ, Fosnaugh RP, Fine G. Lipedematous alopecia. Arch Dermatol 1961;84: 619-22) and termed lipoedematous alopecia. Our case was associated with a raised BMI and also with an ichthyosiform rash on her shins, which started when she was in her teens and needs further evaluation after the COVID-19 pandemic. It was also associated with scarring alopecia rather than nonscarring alopecia, as seen in other cases. We wonder if there is a genetic cause as the disease predominantly occurs in African patients. Also, lipoedematous alopecia may be associated with nonscarring alopecia, as well as scarring alopecia, as seen in our case.

Symptoms persisting after hospitalization for COVID-19: 12 months interim results of the CO-FLOW study

After COVID-19 long-term sequelae are frequently reported. We aimed to longitudinally assess persistence and clusters of symptoms up to 12 months after hospitalization for COVID-19, and to assess determinants of the main persistent symptoms. In this multicenter prospective cohort study patients with COVID-19 are followed up at 3, 6, and 12 months after hospital discharge;we present interim results for persistent symptoms up to 12 months. Symptoms were clustered into physical, respiratory, cognitive, and fatigue symptoms. Of the 492 patients included, 97%, 95.5%, and 92.5% had at least 1 persisting symptom at 3, 6, and 12 months after discharge, respectively (p=0.010). Muscle weakness, exertional dyspnea, fatigue, and memory and concentration problems were the most prevalent symptoms at follow-up (>50%). Over time, muscle weakness, hair loss, and exertional dyspnea decreased significantly (p<0.001). Only the physical (p=0.025) and respiratory (p<0.001) symptom cluster declined significantly over time. Female gender was the most important predictor of persistent symptoms and co-occurrence of symptoms from all clusters. Shorter hospital stay and treatment with steroids were related to decreased muscle weakness;comorbidity and being employed were related to increased fatigue;and shorter hospital stay and comorbidity were related to memory problems. The majority of patients experienced COVID-19 sequelae up to 12 months after hospitalization. Only the physical and respiratory symptoms showed slow gradual decline. This finding stresses the importance of finding the underlying causes and effective treatments for post-COVID condition, beside adequate COVID-19 prevention.

The association of hair loss and coronavirus infection COVID-19 – facts and hypotheses

The main manifestations of COVID-19 are primarily interstitial pneumonia and respiratory failure. No less than 20% of patients have variable skin rashes, which try to be interpreted as markers and predictors of the peculiarities of the course of coronavirus infection. In addition, hair loss is a characteristic manifestation of COVID-19, and the salivary follicles are regarded as a target for SARS-CoV-2. The most common variants of alopecia in patients with a new coronavirus infection or vaccine-induced alopecia are acute telogenic, nondescript, and androgenetic alopecia. This review provides information on the most common variants of hair loss in patients with SARS-CoV-2 infection, the features of their manifestations, and possible mechanisms of development. Acute telogenic hair loss is the most common variant of SARS-CoV-2-induced alopecia, is characteristic of patients with subacute course of COVID-19 and can be combined with trichodynia, anosmia and aguvia, which are markers of nervous system damage. Given the variability in the time of onset after infection, a heterogeneous pathogenesis of alopecia can be assumed. Nested alo-pecia after COVID-19 is often a relapse of the disease, its severity and frequency do not correlate with the severity of the infectious disease, and its prevalence in women indicates the importance of hormonal factors in its development. Androgenetic alopecia may be a predictor of high risk of infection, severe course, and recurrence of COVID-19. The first two variants of alopecia may be associated with COVID-19 vaccination, and the latter is a predictor of inadequate immune response to vaccine administration. The mechanisms of the damaging effects of SARS-CoV-2 on hair follicles have not been fully deciphered and are most likely complex, with different leading links in different types of hair loss. Deciphering these mechanisms may provide prerequisites for understanding the mechanisms of COVID-19 damage to other tissues and organs. © Smirnova I.O. 2023.

Clinico-Epidemiological Profile of Cutaneous Adverse Drug Reactions at Rural Tertiary Care Centre

Background: Cutaneous adverse drug reactions (CADRs), also known as toxidermia, are skin manifestations resulting from systemic drug administration and it constituted 10%-30% among all reported adverse drug reactions (ADRs). These reactions range from mild morbilliform drug rash to much more severe reactions. Material(s) and Method(s): A retrospective observational study was conducted at dermatology outpatient department of rural based tertiary care center for a duration of 03 years from August 2019 to July 2022, a total of 211 patients who had been clinically diagnosed or were suspected to have drug reactions were studied. Result(s): In this observation there was male preponderance (59.72%) and majority of patients were in their 3rd and 4th decade (40.28%) with maculopapular drug rash (33.17%) being most common clinical profile of CADRs, followed by urticaria (23.70%). Less frequently seen CADRs were acneiform eruptions (21), hair Loss (9), photodermatitis (9), generalised pruritus (7), erythroderma (2), pityriasis rosea (2), Stevens Johnson Syndrome-Toxic Epidermal Necrolysis (SJS-TEN) (4), lichenoid drug eruptions (3), Vasculitis (1) and pustular drug eruption (1). The most common group of drugs causing CADRs were antibiotics (40.28%), followed by NSAIDs (28.43%). Conclusion(s): Cutaneous Adverse Drug Reactions (CADRs) are price we pay for the benefits of modern drug therapy;knowledge of these reactions is important for treating physician as prompt recognition and treatment can prove lifesaving.Copyright © 2022 Academic Medicine and Pharmacy

Self-Reported Hair Loss Following COVID-19: An Observational Study

Objective: COVID-19 has been significantly associated with both psychosocial stress and physiologic stress, both of which are known to trigger telogen effluvium. This study was performed to estimate the prevalence of hair loss among patients with COVID-19 and to determine the correlation of the severity of COVID-19 with the severity of hair loss. Method(s): Data were collected through a self-administered electronic questionnaire that was distributed among social media platforms. Participants were invited to complete the survey using a convenience sampling technique. A multiple response dichotomies analysis and chi-square test of independence were used to analyze data. Result(s): Among 420 participants who reported a positive PCR result of SARS-CoV-2, 77.6% reported hair loss after COVID-19 development. Notably, the onset of hair loss was within 3 weeks of COVID-19 development in 29% of participants. Most of the participants reported that the duration of hair loss was up to 6 months, and hair regrowth was noticed within 1 year after COVID-19 development. Patients who were admitted to the hospital, who experienced respiratory difficulties, who had lost weight due to COVID-19, and who experienced symptoms for longer than 10 days were significantly more prone to experience severe hair loss following COVID-19 (P < 0.001). Conclusion(s): This study demonstrated a high frequency of self-reported hair loss after the development of COVID-19. Interestingly, even patients with mild COVID-19 symptoms were significantly more prone to experience moderate hair loss. Unique to COVID-19 infection, the onset of hair loss following the development of COVID-19 was within 3 weeks in one-third of the participants. Copyright © 2022 Hospital for Skin Diseases.

COVID-19 Stress on Mental and Hair Health: A Marker for Diseases in the Post-Pandemic Era

The seriousness of the COVID-19 pandemic with accumulating stress factors, including lack of pharmacotherapy, quarantine, social distancing, delay of vaccination, and economic uncertainties, may foster fear and psychiatric disorders that can precipitate or aggravate hair/scalp disease. Hair loss can lead to decreased self-esteem, potentiating the negative effects on social life and generating a vicious cycle of stress during the pandemic. The relationship between environment and behavior can also trigger epigenetic changes in diseases, which may influence the health of the next generations. In this review, we describe the interaction between the physiological mechanisms of stress on hair follicles and hair disorders and openly discuss during pandemic/post-pandemic (not genetically determined but epigenetically triggered) hair loss as a point of concern as a health marker for further development of chronic diseases, such as diabetes, obesity, psychiatric disorders, and others.Copyright © 2022 Bentham Science Publishers.

A Randomized, Double-Blind, Placebo-Controlled Phase II Study to Evaluate the Efficacy and Safety of Ivarmacitinib (SHR0302) in Adult Patients with Moderate to Severe Alopecia Areata.

BACKGROUND: Alopecia areata (AA) is a CD8+ T cell mediated autoimmune disease characterized by non-scarring hair loss. Ivarmacitinib, a selective oral Janus kinase 1 (JAK1) inhibitor, may interrupt certain cytokine signaling implicated in the pathogenesis of AA. OBJECTIVE: To evaluate the efficacy and safety of ivarmacitinib in adult AA patients who have ≥25% scalp hair loss. METHODS: Eligible patients were randomized 1:1:1:1 to receive ivarmacitinib 2 mg, 4 mg, or 8 mg QD or placebo for 24 weeks. The primary endpoint was percentage change from baseline in Severity of Alopecia Tool (SALT) score at week 24. RESULTS: A total of 94 patients were randomized. At week 24, the least squares mean (LSM) difference in percentage change from baseline in SALT score for ivarmacitinib 2 mg,4 mg, 8 mg, and placebo groups were -30.51% (90% confidence interval [CI]: -45.25, -15.76), -56.11% (90% CI: -70.28, -41.95), -51.01% (90% CI: -65.20, -36.82) and -19.87% (90% CI: -33.99, -5.75), respectively. Two SAEs, follicular lymphoma, and COVID-19 pneumonia were reported. LIMITATIONS: Small sample size limits the generalizability of the results. CONCLUSION: Treatment with ivarmacitinib 4 mg and 8 mg doses in moderate and severe AA patients for 24 weeks was efficacious and generally tolerated.

Symptom Profile of Patients With Post-COVID-19 Conditions and Influencing Factors for Recovery.

Background: The aim of the study was to examine the factors that influence the improvement of post-coronavirus disease 2019 (COVID-19) symptoms. Methods: We investigated the biomarkers and post-COVID-19 symptoms status of 120 post-COVID-19 symptomatic outpatients (44 males and 76 females) visiting our hospital. This study was a retrospective analysis, so we analyzed the course of symptoms only for those who could follow the progress of the symptoms for 12 weeks. We analyzed the data including the intake of zinc acetate hydrate. Results: The main symptoms that remained after 12 weeks were, in descending order: taste disorder, olfactory disorder, hair loss, and fatigue. Fatigue was improved in all cases treated with zinc acetate hydrate 8 weeks later, exhibiting a significant difference from the untreated group (P = 0.030). The similar trend was observed even 12 weeks later, although there was no significant difference (P = 0.060). With respect to hair loss, the group treated with zinc acetate hydrate showed significant improvements 4, 8, and 12 weeks later, compared with the untreated group (P = 0.002, P = 0.002, and P = 0.006). Conclusion: Zinc acetate hydrate may improve fatigue and hair loss as symptoms after contracting COVID-19.

COVID-19 infection is a major cause of acute telogen effluvium.

BACKGROUND: Acute telogen effluvium is a non-scaring hair loss, usually occurs 3 months after the stressful event that causes hair shedding, and lasts up to 6 months. It can be associated with post COVID-19 infection. OBJECTIVE: To study the possible effects of COVID-19 on the hair growth cycle and the relationship between COVID-19 and acute telogen effluvium. PATIENTS AND METHODS: This is an observational cross-sectional study that had been conducted during the period from September 2020 to March 2021 years. Thirty-nine patients with post COVID-19 hair loss are confirmed by polymerase chain reaction (PCR) or antibody testing. Hair pull test was carried out to confirm the diagnosis and severity of telogen effluvium. RESULTS: Thirty-nine patients were evaluated; their ages ranged from 22 to 67 years with a mean and SD of 41.3 ± 11.6 years with 36 (92.3%) females and 3 (7.69%) males. All patients with a diagnosis of ATE were enrolled in this study and had a laboratory-confirmed diagnosis of prior SARS-CoV-2 infection; 15 (38.46%) patients reported mild symptoms, 24 (61.53%) patients presented with moderate disease, and no patient required hospitalization. They all experienced excessive hair loss within 2-3 months after infection. Pull tests were strongly positive (> 10-50% with a mean of 35% of pulled hair away from scalp). CONCLUSION: COVID-19 infection is now a frequent and a common cause of acute telogen effluvium. Hence, clinicians should be aware about the relation between this infection and this pattern of hair loss. Drugs that have been used for the treatment of COVID-19 were excluded as a cause of acute telogen effluvium.

Hair Loss and Androgen's Role in the Era of COVID-19

The new coronavirus (SARS-COV2), which causes coronavirus illness, has expanded globally, impacting millions of individuals. In comparison to female patients, males have a higher prevalence, morbidity, and death rate from this condition, according to international statistics. Androgens have been implicated in the pathophysiology of COVID-19. This review's objective is to explain the potential connection between the pathophysiology of androgen and the infectivity mechanism of the coronavirus as well as the association between SARS-COV2 and hair disorders. This might assist in clarifying androgen's involvement in COVID-19 prognosis and therapy.

Stress, anxiety, depression and long COVID symptoms

Background: The development of depression and anxiety symptoms during long COVID may partly result from the biopsychosocial effects of COVID-19 that impact mental health, rather than from the infection alone. Aim: The present study examined the association of anxiety, depression, stress, and psychological distress levels with sociodemographic factors and symptom severity during and three months after the acute phase of COVID-19. Methods: This cross-sectional study included 119 participants with a positive SARS-CoV-2 qPCR test. Three months after the acute phase of infection, participants completed an online survey to collect clinical information and sociodemographic data, followed by completion of the Impact of Event Scale-Revised, Depression, Anxiety, and Stress scales. Results: During and after infection, fatigue was the most frequently reported symptom. After the acute phase of COVID-19, substantial numbers of participants presented moderate to severe psychological distress (28.5%), severe to extremely severe depression (26.05%), and severe to extremely severe stress (31.09%). Female patients presented higher stress scores than males, while individuals who reported having lost a loved one presented high psychological distress, anxiety, and depression. The presence of physical symptoms after COVID-19 and other factors such as being a woman, being married, having children, or living with someone who suffers from a disease increased vulnerability to depression, stress, and anxiety. Conclusions: There are psychological consequences for survivors of COVID-19 associated with sociodemographic factors. Clinical strategies are needed to provide mental health care for individuals with long COVID symptoms. © 2022 IACFS/ME.

Alopecia Areata after COVID-19 Vaccines.

Introduction: Alopecia areata (AA) is a common autoimmune disease characterized by non-scarring hair loss. New onsets of AA have been associated with coronavirus disease 2019 (COVID-19). Various skin diseases have already been reported because of the vaccines (the Pfizer-BioNTech COVID-19 vaccine, the Moderna COVID-19 vaccine, the AstraZeneca vaccine) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Case Presentation: We report 5 cases of AA after COVID-19 vaccination. The trend shown by patients in this study is an initial worsening after the first dose of the vaccine with the stability of the disease even with subsequent doses. However, it is worth highlighting the case reported by one of our patients who suffered a "booster effect" of the disease with progressive and worsening alopecia with each vaccine booster. Discussion: The possible mechanism of action lies in the ability of COVID-19 vaccines to induce spike protein, which can lead to molecular mimicry phenomena. In an organism predisposed to autoimmunity, the mRNA vaccine acts as a trigger. Furthermore, we would like to point out how even cytokine storm and simple oxidative stress from SARS-CoV-2 infection can induce not only AA but also other types of hair loss such as telogen effluvium. Thus, this highlights how complex and multifaceted the phenomenon is.

Hair Loss and Androgen's Role in the Era of COVID-19

The new coronavirus (SARS-COV2), which causes coronavirus illness, has expanded globally, impacting millions of individuals. In comparison to female patients, males have a higher prevalence, morbidity, and death rate from this condition, according to international statistics. Androgens have been implicated in the pathophysiology of COVID-19. This review's objective is to explain the potential connection between the pathophysiology of androgen and the infectivity mechanism of the coronavirus as well as the association between SARS-COV2 and hair disorders. This might assist in clarifying androgen's involvement in COVID-19 prognosis and therapy. © 2022, International Medical Research and Development Corporation. All rights reserved.