key: cord-0766060-nev36700
authors: Miola, Anna Carolina; Florêncio, Lívia Caramaschi; Ribeiro, Maria Estela Bellini; Alcântara, Giovana Piteri; Ramos, Paulo Müller; Miot, Hélio Amante
title: Early onset effluvium secondary to COVID-19: A clinical and histological characterization
date: 2021-12-11
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2021.09.072
sha: 074694afd69e2963328f82547f6d3c08484e4c94
doc_id: 766060
cord_uid: nev36700

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Clinically, all cases presented a positive pull test. Trichoscopy did not reveal 62 broken hairs, anisotrichosis, or yellow dots, but it did show some empty follicles. The 63 trichogram from the vertex presented >10% dystrophic anagen hairs (figure 1) and 64 >20% telogen hairs in all cases. Histologically, there is a predominance of anagen 65 terminal follicles, no relevant miniaturization (>10%), and no cases showed more than 66 25% telogen follicles. No inflammation was evident at the epidermis or throughout the 67 hair follicle (figure 2). 68

Post-infectious hair shedding has traditionally been classified as an acute TE; 69 however, the hair follicle may respond to infection and inflammation in different ways. A 70 more intense insult could also lead to dystrophic anagen effluvium, which presents as 71 an early onset, as we have demonstrated here. Under COVID-19, the cytokine storm 72 during the inflammatory phase (especially IL6 and TNFα), the severe hypoxia, the 73 oxidative stress, the microthrombotic events and the toxicity of the multiple drugs used 74 for treatment could play a role, especially in the more severe cases. These issues can 75 elicit TE by multiple mechanisms following COVID-19, which can justify different 76 patterns of presentation and time to onset of hair loss. 77

Further studies exploring the pathogenesis of the early effluvium elicited by 78 COVID-19, as well as its prevalence and possible differences from other acute post-79 infectious TE, are needed. 

Time of onset and duration of post-COVID-84 19 acute telogen effluvium

Telogen effluvium: a comprehensive review

Telogen effluvium. New concepts and review

SARS-CoV-2-induced 90 telogen effluvium: a multicentric study

Trichodynia and telogen effluvium in COVID-19 92 patients-results of an international expert opinion survey on diagnosis and management