key: cord-0913765-o1mypsqq
authors: Phong, Celine H.; Babadjouni, Arash; Nguyen, Cristina; Kraus, Christina N.; Mesinkovska, Natasha Atanaskova
title: Not just thinning: A case of alopecia universalis after a mild COVID-19 infection
date: 2022-05-07
journal: JAAD Case Rep
DOI: 10.1016/j.jdcr.2022.04.024
sha: 79932f38e0c76635afec9e3899ee6a89aed588ac
doc_id: 913765
cord_uid: o1mypsqq

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The majority of COVID-19 infections are considered mild in severity (81%), 9 defined by 50 the National Institutes of Health as having signs and symptoms such as fever, cough, loss of taste 51 or smell, and diarrhea, but without dyspnea or abnormal chest imaging. While we do not usually 52 expect mild cases to have severe impact on hair, we report a case of a patient with rapid onset, de 53 novo AA that presented in a diffuse pattern and in the early stages was clinically 54 indistinguishable from TE. Barr virus, as well as hepatitis A or B virus vaccination, has been shown to be associated with 98 AA. 10 The purported mechanisms are speculated to be primarily driven by the pro-inflammatory 99 cytokine response to the SARS-CoV-2 virus, rather than direct viral or associated psychogenic 100 stress related to the infection. Viruses may trigger AA via an antiviral interferon mediated 101 response, a TH1 promoting cytokine which induces major histocompatibility complex class I 102 expression in the proximal outer root sheath of the hair follicle, resulting in its loss of immune privilege. 5 Also, viral infections may cause a large release of pro-inflammatory cytokines, 104 including interleukin-6 (IL-6), a TH2 promoting cytokine which plays a significant role in 105 COVID-19 and the hair follicle cycle 2 . While AA conventionally belongs to the TH1-mediated 106 adaptive immune system regulation, the contributing TH2 component is becoming more evident. 107

Other potential mechanisms for how viral infections may trigger AA include downregulation of 108 immunosuppressive cytokines, 11 molecular mimicry, super antigens, and epitope spreading. 

COVID-19 induced telogen effluvium

Dermatologic Therapy

Telogen Effluvium after SARS-CoV-2 Infection: A 128 Series of Cases and Possible Pathogenetic Mechanisms

Dengue virus infects primary human hair follicle dermal 131 papilla cells

Mild-to-134 moderate COVID-19 is not associated with worsening of alopecia areata: A retrospective 135 analysis of 32 patients

New onset of alopecia areata in a patient with SARS-138

CoV-2 infection: Possible pathogenetic correlations

Alopecia areata in a COVID-19 patient: A 141 case report

COVID-19: association with rapidly progressive forms of alopecia areata

Rapidly progressive alopecia areata totalis in a COVID-19 patient, unresponsive 146 to tofacitinib

Characteristics of and Important Lessons from the Coronavirus 149 Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases from 150 the Chinese Center for Disease Control and Prevention

Gilhar A. Collapse of immune privilege in alopecia areata: Coincidental or substantial