Safety of Janus Kinase inhibitors in Patients with Alopecia Areata: A Systematic Review.

BACKGROUND AND OBJECTIVES: Janus kinase (JAK) inhibitors are emerging as a therapeutic option for alopecia areata. The risk of potential adverse events is currently debated. In particular, several safety data for JAK inhibitors are extrapolated from a single study in elderly patients with rheumatoid arthritis treated with tofacitinib or adalimumab/etanercept as a comparator. The population of patients with alopecia areata is clinically and immunologically different from persons with rheumatoid arthritis and tumor necrosis factor (TNF) inhibitors are not effective in these patients. The objective of this systematic review was to analyze available data on the safety of various JAK inhibitors in patients with alopecia areata. METHODS: The systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature review was performed by searching PubMed, Scopus and EBSCO databases with the last search on March 13, 2023. RESULTS: In total, 36 studies were included. The frequency and odds ratio (OR) for most common adverse events versus placebo were: for baricitinib hypercholesterolemia (18.2% vs 10.5%, OR = 1.9) and headache (6.1% vs 5.1%, OR = 1.2), for brepocitinib elevated creatinine level (27.7% vs 4.3%, OR = 8.6) and acne (10.6% vs 4.3%, OR = 2.7), for ritlecitinib acne (10.4% vs 4.3%, OR = 2.6) and headache (12.5% vs 10.6%, OR = 1.2) and for deuruxolitinib headache (21.4% vs 9.1%, OR = 2.7) and acne (13.6% vs 4.5%, OR = 3.3). The respective numbers for upper respiratory infections were: baricitinib (7.3% vs 7.0%, OR = 1.0) and brepocitinib (23.4% vs 10.6%, OR = 2.6); for nasopharyngitis: ritlecitinib (12.5% vs 12.8%, OR = 1.0) and deuruxolitinib (14.6% vs 2.3%, OR = 7.3). CONCLUSIONS: The most common side effects of JAK inhibitors in patients with alopecia areata were headache and acne. The OR for upper respiratory tract infections varied from over 7-fold increased to comparable to placebo. The risk of serious adverse events was not increased.

Recalcitrant Cutaneous Lupus Erythematosus during COVID-19 Pandemic: A Case Report.

A 30-year-old woman visited the dermatology and venereology clinic with red rashes on her cheeks with spreading wounds to the ears present for 6 months. Similar ailments were also found on the chest and upper arms accompanying black spots on both palms. Initially, red rashes appeared intermittently, observed around the eyes and cheeks, especially at sun exposure. Tenderness or pruritus was not present; however, the patient had joints ache, sore fingers, hair loss as well as frequent fever.

Autologous Platelet-Rich Plasma Treatment for Androgenic Alopecia: A Systematic Review and Meta-Analysis of Clinical Trials.

BACKGROUND: Androgenic alopecia (AGA) is a common condition associated with hair loss in both men and women (female pattern hair loss), causing considerable psychological distress. Ongoing research focuses on novel safe, cost-effective, and efficient treatments with the best patient outcomes. Autologous platelet-rich plasma (PRP) has become increasingly popular in the treatment of AGA compared with hair transplantation techniques. The present study aims to evaluate the outcomes of PRP as a treatment for AGA/female pattern hair loss. METHODS: A computerized literature search was conducted on PubMed, clinicaltrials.gov , and Cochrane Library for articles published until November of 2020. The online screening process was performed by two independent reviewers with the Covidence tool against set inclusion/exclusion criteria. The protocol was reported following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health and Care Research. Meta-analyses were performed by using the random effects model with the RevMan software. RESULTS: The initial search yielded 49 randomized controlled clinical trials. Eleven randomized controlled clinical trials were included in the study based on a priori criteria. PRP injections significantly increased the number of hair follicles, hair thickness, and density compared with placebo interventions. Also, the patients reported high overall satisfaction with the PRP treatment. Only temporary minor side effects were noted, including localized pain, bleeding, and itching. CONCLUSIONS: Autologous PRP significantly improves alopecia in select patients. Future research should focus on optimizing PRP treatment protocols and minimizing possible adverse reactions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Prevalence of and risk factors for post-COVID: Results from a survey of 6,958 patients from Brazil.

A plethora of prolonged COVID-19 symptoms, or late manifestations has been reported after acute disease and labeled "post-COVID". The aim of this study was to identify the prevalence of and risk factors for post-COVID up to 12 weeks after the onset of acute COVID-19. An electronic survey was conducted to evaluate post-COVID-19 symptoms, disease severity, demographics, and pre-existing diseases. The participants were recruited through 88,648 SMS messages, and post on social media. The associations between variables were explored through multivariate models. From 6,958 respondents with confirmed COVID-19, 753 (10.8%) required hospitalization, and 5,791 (83.2%) exhibited at least one post-COVID manifestation. Hair loss (49.4%), memory loss (40.7%), low attention (37.0%), fatigue (34.2%), anxiety (31.2%), and headache (29.6%) were the most reported post-COVID manifestations. Female sex, myalgia, anosmia, and severe disease were associated with most post-COVID manifestations. Pre-existing depression was associated with the development of neuropsychiatric manifestations. Post-COVID manifestations were identified in most patients following COVID-19 infection, placing a supplementary burden on the healthcare system. Hair loss, fatigue, and neuropsychiatric symptoms were the most prevalent post-COVID manifestations. Female sex, myalgia, anosmia, and more severe disease are risk factors for multiple post-COVID manifestations.

A cross-sectional, multicenter survey of the prevalence and risk factors for Long COVID.

Long-term sequelae of the coronavirus disease (COVID-19) constitute Long COVID. Although Long COVID has been reported globally, its risk factors and effects on quality of life (QOL) remain unclear. We conducted a cross-sectional study using questionnaires and electronic medical records of COVID-19 patients who were diagnosed or hospitalized at five facilities in Japan. Responses were obtained from 285 out of 1,150 patients. More than half of the participants reported Long COVID symptoms of varying severity 1 year after COVID-19. Common sequelae included fatigue, dyspnea, alopecia, concentration problems, memory problems, sleeplessness, and joint pain, which often significantly reduced their QOL. COVID-19 severity was strongly associated with sputum production, chest pain, dyspnea, sore throat, and diarrhea, but not with fatigue, dysgeusia, anosmia, alopecia, and sleeplessness. Fatigue, dysgeusia, anosmia, alopecia, and sleeplessness affected the QOL among participants with asymptomatic or mild COVID-19 during the acute phase. Moreover, these sequelae persisted for prolonged periods.

An impressive case of alopecia universalis after COVID-19 vaccination: a coincidental finding or a consequence?

BACKGROUND: Several cutaneous manifestations in patients undergoing COVID-19 vaccination have been described in literature. CASE REPORT: Herein, we present a case of alopecia universalis that occurred after the first and second dose of Comirnaty vaccine. A bibliographic search was conducted and a total of 14 studies concerning the association were reviewed. CONCLUSIONS: Given the autoimmune pathogenesis of the disease, we discussed the potential role of SARS-CoV-2 infection and vaccination as a trigger for the development of hair loss. Physicians should be aware of SARS-CoV-2 vaccine-related hair loss and properly treat this undesirable effect.

Telogen Effluvium and COVID-19: a case and a brief review of literature / Eflúvio Telógeno e COVID-19: um caso e uma breve revisão de literatura

COVID-19 is a new disease that has brought a great impact on global morbidity and mortality. There have been increasingly frequent reports of persistent symptoms and/or clinical manifestations attributed to COVID-19 after the acute phase of the disease. In this article, we present a case of post-COVID-19 telogen effluvium in a 39-year-old hypertensive and obese patient who looked for medical attention due to massive hair loss. Previous history of moderate COVID-19 4 months ago. After investigation and exclusion of other possible causes of telogen effluvium well established in the literature, the condition was attributed to the previous episode of COVID-19. Persistent fever, the cytokine storm, and the entire immunological cascade of COVID-19 can lead to apoptosis of the keratinocytes of the hair follicles, initiating the catagen phase early followed by the telogen phase with a consequent capillary release. Late symptoms possibly secondary to COVID-19 should receive attention and interest from the medical and scientific community. As it is a new disease, whose late consequences are not yet fully known/elucidated, careful observation and careful clinical follow-up of these patients are recommended (AU)

A COVID-19 é uma doença nova que vem provocando grande impacto na morbimortalidade mundial. Relatos de persistência de sintomas e/ou manifestações clínicas atribuídas à COVID-19 após a fase aguda da doença tem sido cada vez mais frequentes. Neste artigo, apresentamos um caso de eflúvio telógeno pós COVID-19 em um paciente de 39 anos, hipertenso e obeso, que procurou atendimento médico devido à queda volumosa de cabelos. Histórico prévio de COVID-19 moderada há 4 meses. Após investigação e exclusão de outras possíveis causas de eflúvio telógeno bem estabelecidas na literatura o quadro foi atribuído ao episódio prévio de COVID-19. É possível que a febre persistente, a tempestade de citocinas e toda a cascata imunológica da COVID-19 possam levar à apoptose dos queratinócitos dos folículos capilares, iniciando, assim, precocemente a fase catágena seguida pela fase telógena com consequente liberação capilar. Sintomas tardios possivelmente secundários à COVID-19 devem ser alvo de atenção e interesse da comunidade médica e científica. Por se tratar de uma doença nova, cujas consequências tardias ainda não se encontram completamente conhecidas/ elucidadas, recomenda-se a observação atenta e o seguimento clínico criterioso desses pacientes (AU)

[The Evaluation of Long Coronavirus Disease Symptoms at Ninth Month from a Hospital in Türkiye]. / Türkiye'deki Bir Hastanede Dokuzuncu Ayda Uzamis Koronavirüs Hastaligi Belirtilerinin Degerlendirilmesi.

Long COVID is defined as symptoms related to various organs following COVID-19. There is currently very little information available about the prevalence of these symptoms and their long-term recovery time. The aim of this study was to describe the symptoms that persisted nine months after COVID-19. This cross-sectional study was conducted in Antalya, Türkiye, between November 1 and 30, 2020 on COVID-19 patients. Patients were contacted approximately nine months later by two infectious diseases physicians, and the questionnaire which included 27 symptoms was completed. Of the 390 patients who met the criteria, 329 agreed to participate in the study. Patients' average age was 48.9 ± 14.4 years, and 51.7% were male. 79.3% of the people still had at least one symptom at the end of the ninth month. The most common symptoms were weakness-fatigue (54.7%), forgetfulness (45.3%), effort loss (35.0%), sleep disturbance (34.3%), joint pain (27.4%), and hair loss (23.4%). According to analysis performed in terms of sex; hair loss, diarrhea, nausea, dizziness, sore throat, loss of taste and smell were more common in women than in men (p= 0.042, p= 0.047, p= 0.050, p= 0.026, p= 0.016, p= 0.036, p= 0.027, respectively). Individuals aged 65 years and over had a significantly lower number of symptoms (p= 0.029) than all other age groups. Furthermore, the number of symptoms was higher in patients who used steroids (p= 0.049). This study is an important source of information on the long-term symptoms of COVID-19. Our results have shown that the symptoms associated with COVID-19 do not completely resolve even after nine months, which explains why long COVID requires continuous monitoring.

Hormonal trends in patients suffering from long COVID symptoms.

Symptoms of long COVID are complex and long-lasting, and endocrine dysfunction might be involved in the underlying mechanisms. In this study, to clarify the hormonal characteristics of long COVID patients, laboratory data for patients who visited the outpatient clinic for long COVID were evaluated. A retrospective analysis was performed for patients who visited Okayama University Hospital during the period from Feb 2021 to Dec 2021 with focus on the interrelationships between major symptoms and endocrine data. Information and laboratory data were obtained from medical records for 186 patients. The patients had various symptoms, and the most frequent symptoms were general malaise, dysosmia/dysgeusia, hair loss, headache, dyspnea, and sleeplessness. Patients who were suffering from fatigue and dysosmia/dysgeusia were younger, while hair loss was more frequent in older and female patients. As for the characteristics of patients suffering from general fatigue, the scores of depression and fatigue were positively correlated with serum levels of cortisol and free thyroxin (FT4), respectively. Also, patients suffering from general fatigue had lower levels of serum growth hormone and higher levels of serum FT4, while patients with dysosmia/dysgeusia had a significantly lower level of serum cortisol. Serum thyrotropin (TSH) levels were higher and the ratios of FT4/TSH were lower in the initially severe cases, suggesting occult hypothyroidism. In addition, the ratios of plasma adrenocorticotropin to serum cortisol were decreased in patients with relatively high titers of serum SARS-CoV-2 antibody. Thus, hormonal changes seem to be, at least in part, involved in the persistent symptoms of long COVID.

SARS-CoV-2 vaccination in androgen sensitive phenotypes - A study on associated factors for SARS-CoV-2 vaccination and its adverse effects among androgenetic alopecia and benign prostate hyperplasia patients.

Background: Androgen sensitivity, which was established as the leading etiology of androgenetic alopecia (AGA) and benign prostatic hyperplasia (BPH), plays an important role in SARS-CoV-2 infection. Vaccination is essential for AGA and BPH patients in view of the high risk from SARS-CoV-2 infection. Purpose: We aimed to investigate the associated factors for SARS-CoV-2 vaccination and its side effects in populations with AGA and BPH. Method: We collected the data on SARS-CoV-2 vaccination and adverse reactions of male AGA and BPH patients visited the outpatient of Xiangya hospital by telephone and web-based questionnaires. Vaccination rate and adverse reactions were compared by different vaccine types and use of anti-androgen therapy. Result: A total of 457 AGA patients and 397 BPH patients were recruited in this study. Among which, 92.8% AGA patients and 61.0% BPH patients had at least the first dose of SARS-CoV-2 vaccination (p < 0.001). Having comorbidities and use of anti-androgen therapy increased the risk of un-vaccination among AGA by 2.875 and 3.729 times, respectively (p < 0.001). Around 31.1% AGA patients and 9.5% BPH patients presented adverse reactions, which were mostly mild. Anti-androgen therapy increased the inclination of injection site pain after vaccination (18.7% vs 11.9%; OR: 1.708, 95% CI: 1.088-2.683, p = 0.019). Conclusion: Co-existence of other systemic diseases and anti-androgen therapy were the limiting factors for SARS-CoV-2 unvaccination, especially in AGA patients. The importance of SARS-CoV-2 vaccines should be strengthened and popularized in androgen sensitive phenotypes.

Hair Loss and Telogen Effluvium Related to COVID-19: The Potential Implication of Adipose-Derived Mesenchymal Stem Cells and Platelet-Rich Plasma as Regenerative Strategies.

The diffusion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) inducing coronavirus disease 2019 (COVID-19) has increased the incidence of several dermatological disorders, including hair loss (HL). This article aims to review the literature regarding the incidence of HL and telogen effluvium (TE) in COVID-19 patients and critically appraise the available evidence regarding the role of regenerative strategies like Platelet-Rich Plasma (PRP) and Human Follicle Stem Cells (HFSCs). A literature review regarding the correlation of HL and TE in COVID-19 patients analyzing the biomolecular pathway involved and the role of regenerative strategies was performed using PubMed, MEDLINE, Embase, PreMEDLINE, Scopus, and the Cochrane databases. Observational studies revealed an escalated incidence of pattern HL and TE in COVID-19 patients. Psychological stress, systemic inflammation, and oxidative stress are potential culprits. Proinflammatory cytokines and stress hormones negatively affect the normal metabolism of proteoglycans. Reduced anagenic expression of proteoglycans is a potential mediating mechanism that connects HL to COVID-19. Currently, only one study has been published on PRP against HL in COVID-19 patients. Further controlled trials are required to confirm PRP and HFSCs efficacy in COVID-19 patients.

Taxane monotherapy regimens for the treatment of recurrent epithelial ovarian cancer.

BACKGROUND: Ovarian cancer is the seventh most frequent cancer diagnosis worldwide, and the eighth leading cause of cancer mortality. Epithelial ovarian cancer is the most common kind, accounting for 90% of cases. First-line therapy for women with epithelial ovarian cancer consists of a combination of cytoreductive surgery and platinum and taxane-based chemotherapy. However, more than 50% of women with epithelial ovarian cancer will experience a relapse and require further chemotherapy and at some point develop resistance to platinum-based drugs. Currently, guidance on the use of most chemotherapy drugs, including taxanes, is unclear for women whose epithelial ovarian cancer has recurred. Paclitaxel, topotecan, pegylated liposomal doxorubicin hydrochloride, trabectedin and gemcitabine are all licensed for use in the UK at the discretion of clinicians, following discussion with the women as to potential adverse effects. Taxanes can be given in once-weekly regimens (at a lower dose) or three-weekly regimens (at a higher dose), which may have differences in the severity of side effects and effectiveness. As relapsed disease suggests incurable disease, it is all the more important to consider side effects and the impact of treatment schedules, as well as quality of life, and not only the life-prolonging effects of treatment. OBJECTIVES: To assess the efficacy and toxicity of different taxane monotherapy regimens for women with recurrent epithelial ovarian, tubal or primary peritoneal cancer. SEARCH METHODS: We searched CENTRAL, MEDLINE and Embase, up to 22 March 2022. Other related databases and trial registries were searched as well as grey literature and no additional studies were identified. A total of 1500 records were identified. SELECTION CRITERIA: We included randomised controlled trials of taxane monotherapy for adult women diagnosed with recurrent epithelial ovarian, tubal or primary peritoneal cancer, previously treated with platinum-based chemotherapy. We included trials comparing two or more taxane monotherapy regimens. Participants could be experiencing their first recurrence of disease or any line of recurrence. DATA COLLECTION AND ANALYSIS: Two review authors screened, independently assessed studies, and extracted data from the included studies. The clinical outcomes we examined were overall survival, response rate, progression-free survival, neurotoxicity, neutropenia, alopecia, and quality of life. We performed statistical analyses using fixed-effect and random-effects models following standard Cochrane methodology. We rated the certainty of evidence according to the GRADE approach. MAIN RESULTS: Our literature search yielded 1500 records of 1466 studies; no additional studies were identified by searching grey literature or handsearching. We uploaded the search results into Covidence. After the exclusion of 92 duplicates, we screened titles and abstracts of 1374 records. Of these, we identified 24 studies for full-text screening. We included four parallel-group randomised controlled trials (RCTs). All trials were multicentred and conducted in a hospital setting. The studies included 981 eligible participants with recurrent epithelial ovarian cancer, tubal or primary peritoneal cancer with a median age ranging between 56 to 62 years of age. All participants had a WHO (World Health Organization) performance status of between 0 to 2. The proportion of participants with serous histology ranged between 56% to 85%. Participants included women who had platinum-sensitive (71%) and platinum-resistant (29%) relapse. Some participants were taxane pre-treated (5.6%), whilst the majority were taxane-naive (94.4%). No studies were classified as having a high risk of bias for any of the domains in the Cochrane risk of bias tool. We found that there may be little or no difference in overall survival (OS) between weekly paclitaxel and three-weekly paclitaxel, but the evidence is very uncertain (risk ratio (RR) of 0.94, 95% confidence interval (CI) 0.66 to 1.33, two studies, 263 participants, very low-certainty evidence). Similarly, there may be little or no difference in response rate (RR of 1.07, 95% CI 0.78 to 1.48, two studies, 263 participants, very low-certainty evidence) and progression-free survival (PFS) (RR of 0.83, 95% CI 0.46 to 1.52, two studies, 263 participants, very low-certainty evidence) between weekly and three-weekly paclitaxel, but the evidence is very uncertain. We found differences in the chemotherapy-associated adverse events between the weekly and three-weekly paclitaxel regimens. The weekly paclitaxel regimen may result in a reduction in neutropenia (RR 0.51, 95% 0.27 to 0.95, two studies, 260 participants, low-certainty evidence) and alopecia (RR 0.58, 95% CI 0.46 to 0.73, one study, 205 participants, low-certainty evidence). There may be little or no difference in neurotoxicity, but the evidence was very low-certainty and we cannot exclude an effect (RR 0.53, 95% CI 0.19 to 1.45, two studies, 260 participants). When examining the effect of paclitaxel dosage in the three-weekly regimen, the 250 mg/m2 paclitaxel regimen probably causes more neurotoxicity compared to the 175 mg/m2 regimen (RR 0.41, 95% CI 0.21 to 0.80, one study, 330 participants, moderate-certainty evidence). Quality-of-life data were not extractable from any of the included studies. AUTHORS' CONCLUSIONS: Fewer people may experience neutropenia when given weekly rather than three-weekly paclitaxel (low-certainty evidence), although it may make little or no difference to the risk of developing neurotoxicity (very low-certainty evidence). This is based on the participants receiving lower doses of drug more often. However, our confidence in this result is low and the true effect may be substantially different from the estimate of the effect. Weekly paclitaxel probably reduces the risk of alopecia, although the rates in both arms were high (46% versus 79%) (low-certainty evidence). A change to weekly from three-weekly chemotherapy could be considered to reduce the likelihood of toxicity, as it may have little or no negative impact on response rate (very low-certainty evidence), PFS (very low-certainty evidence) or OS (very low-certainty evidence). Three-weekly paclitaxel, given at a dose of 175 mg/m2 compared to a higher dose,probably reduces the risk of neurotoxicity.We are moderately confident in this result; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. A change to 175 mg/m2 paclitaxel (from a higher dose), if a three-weekly regimen is used, probably has little or no negative impact on PFS or OS (very low-certainty evidence).

Retrospective Study of Covid Related Hair Loss.

The Novel Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus two and primarily affects the epithelium of the airways. Multiple cutaneous manifestations of COVID-19 have been reported in the literature. Case reports citing many different types of exanthems and enanthems have been reported to correspond with the initial presentation and diagnosis of COVID-19. Some researchers have even described cutaneous symptoms linked to COVID-19 as an important presenting sign of the infection with COVID-19 in otherwise asymptomatic or minimally symptomatic patients. Hair loss has emerged as a frequently noted side effect of infection with COVID-19 and has been observed in many patients who have recovered from a documented COVID-19 illness. Given the prevalence of the onset of hair loss in patients who have overcome COVID-19, we designed this retrospective study in order to evaluate the prevalence of hair loss, along with histological findings if hair loss was present and response to treatment in 100 patients who presented to our outpatient dermatology clinic for various dermatological conditions and reported a history of having recovered from COVID-19. J Drugs Dermatol. 2022;21(7):724-727. doi:10.36849/JDD.6661.

Prevalence of telogen effluvium hair loss in COVID-19 patients and its relationship with disease severity.

COVID-19 is a concerning global pandemic. Common manifestations are fever and respiratory symptoms. In addition, recent studies reported dermatological manifestations as extrapulmonary signs. One of these is telogen effluvium which is related to post COVID-19 comorbidities. The aim of this study was to assess the prevalence of telogen effluvium among COVID-19 patients. This observational cross-sectional study included 198 patients who were admitted for COVID-19. The PCR test was performed to detect positive cases. After discharge, all patients were interviewed about hair loss. Of these patients, 79 were male (39.9%), and 119 were female (60.1%). The age ranged from 18 to 85 years old. 48 patients showed hair loss. Telogen effluvium (TE) is one of the consequences of the COVID-19 pandemic. COVID-19 leads to more medications and stress situations, which trigger TE.

Characteristics of hair loss after COVID-19: A systematic scoping review.

OBJECTIVE: While there are literature reporting increased incidence of hair loss in COVID-19 patients, insufficient evidence exists on the topic to date. This review aims to identify the existing evidence and clinical characteristics of hair loss with COVID-19 infection. METHODS: Following the PRISMA Extension for Scoping Reviews, MEDLINE and EMBASE were searched for all peer-reviewed articles with relevant keywords including "Alopecia," "Telogen Effluvium (TE)," and "COVID-19" from their inception to November 20, 2021. RESULTS: A total of 26 articles, with 9 observational studies and 17 case reports or series (a total of 58 cases), were included. Most studies dealt with TE. There were no clear trends between COVID-19 severity and the extent of hair loss. Analysis of the 58 cases also found similar results with most of the cases being female (82.8%), the median onset of hair loss of 2.0 months, and the median time to recovery of hair loss of 5.0 months with a resolution rate of 95%. CONCLUSION: While this systematic review revealed uncertainty and a lack of strong evidence regarding the association of COVID-19 and hair loss, hair loss in COVID-19 may mainly include TE and be reversible in nature. Future studies are warranted to determine the detailed pathophysiology and risk factors of hair loss in COVID-19, including possible roles of estrogen, progesterone, and pro-inflammatory cytokines.

Management of hair loss after severe acute respiratory syndrome coronavirus 2 infection: Insight into the pathophysiology with implication for better management.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a pandemic by the World Health Organization, and COVID-19 continues to have a major impact on society. Numerous studies have reported impaired health sequelae after COVID-19 recovery, one of which is hair loss. Individuals with hair loss experience a substantial mental burden, which potentially hinders their social life. However, few studies have systematically analyzed the details including hair loss. Therefore, we conducted a narrative review using PubMed on the frequency, associated comorbidities, disease characteristics, and treatment of hair loss after SARS-CoV-2 infection (HLASCI). Two search strings were used to identify 28 articles. Of note, most of the literature identified on COVID-19 sequelae reported an emergence/occurrence of hair loss. HLASCI is speculated to be composed of a heterogeneous population, with the onset or exacerbation of telogen effluvium (TE), anagen effluvium, androgenetic alopecia (AGA), and alopecia areata (AA) reported as possible underlying mechanisms. Among these, acute TE is thought to be the primary cause of HLASCI, with COVID-19 treatment and TE improvement being considered crucial for HLASCI management. An association between COVID-19 and AA exacerbation has also been implicated with still insufficient evidence. Spontaneous recovery of TE can be expected once infection reduces; however, faster improvement in symptoms is expected to reduce the mental and social burden of patients. An additional search string identified 11 articles about TE treatment which suggested that the use of minoxidil may be beneficial. Topical minoxidil has been widely used for AGA patients, who have been speculated to exhibit poor resistance to SARS-CoV-2. Topical minoxidil may provide relief from HLASCI, but future clinical research is warranted to confirm this observation.