Alopecia areata may be a dermatological manifestation of the COVID-19 infection, SARS-CoV-2, according to findings from a study published in JAAD International.
A systematic literature review was performed to examine existing literature for clinical studies and reports analyzing the development of new-onset alopecia areata or the worsening of pre-existing alopecia areata after infection with SARS-CoV-2. Only 9 studies met inclusion criteria and were included in this review. In all, 6 articles were case reports of patients with new-onset alopecia areata after a confirmed SARS-CoV-2 infection and 3 articles covered alopecia areata recurrence or exacerbation after a confirmed SARS-CoV-2 infection in patients with the pre-existing disease. These 9 included studies were published between November 2020 and September 2021, with 89% of them published in 2021. There was 1 study each from the United States, Brazil, and Poland, 4 studies from Italy, and 2 from Turkey.
In n the patients with no past history of alopecia areata, patients were 37 years of age (age range, 13-56 years), 57% of patients were women, and no patients had a personal or familyhistory of the disease. In all patients, the time to alopecia areata diagnosis after COVID-19 was between 4 to 8 weeks with varying presentation characteristics. In the 3 articles in which alopecia areata was a pre-existing condition, 1 was a retrospective analysis, 1 a cross-sectional study, and 1 was a case report. In the retrospective analysis, there was no significant worsening of alopecia areata noted in the 6 months following SARS-CoV-2 infection. In the cross-sectional study, of the 34% of patient participants who reported contracting COVID-19, 44% reported an alopecia areata relapse at around 2 months after infection. In the case study, a 24-year-old woman was successfully managing her alopecia areata with medication, discontinued medication after testing positive for COVID-19, and experienced rapid onset of alopecia areata. After medication resumption the patient failed to show any clinical improvement after 3 months.
Limitations to this study include the use of a single reviewer for article screening, risk of bias assessment, and a limited number of diverse articles, with a high percentage of case reports.
Researchers concluded that, “Since the beginning of the SARS-CoV-2 pandemic in December 2019, various cases on the development of alopecia areata in the 2 months following COVID-19 have been reported. Other studies investigating the worsening of pre-existing alopecia areata in afflicted patients are limited and have produced inconclusive results. An informed understanding of this relationship may improve patient outcomes both in terms of dermatologic treatment and psychological well-being.”
Christensen RE, Jafferany M. Association between alopecia areata and COVID-19: A Systematic Review.JAAD International (2022), doi:https://doi.org/10.1016/j.jdin.2022.02.002.