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

Starace, Michela; Iorizzo, Matilde; Sechi, Andrea; Alessandrini, Aurora Maria; Carpanese, Miriam; Bruni, Francesca; Vara, MD Giulio; Apalla, Zoe; Asz-Sigall, Daniel; Barruscotti, Stefania; Camacho, Francisco; Doche, Isabella; Estrada, Bruna Duque; Dhurat, Rachita; Gavazzoni, Maria Fernanda; Grimalt, Ramon; Harries, Matthew; Ioannidis, Dimitrios; McMichael, Amy; Melo, Daniel Fernandes; Oliveira, Rui; Ovcharenko, Yuliya; Pirmez, Rodrigo; Ramot, Yuval; Rudnicka, Lidia; Shapiro, Jerry; Silyuk, Tatiana; Sinclair, Rodney; Tosti, Antonella; Vano-Galvan, Sergio; Piraccini, Bianca Maria

Background Cutaneous manifestations of COVID-19 may be useful disease markers and prognostic indicators. Recently, post-infectious telogen effluvium and trichodynia have also been reported. Objective To evaluate the presence of trichodynia and telogen effluvium in patients with COVID-19 and describe their characteristics in relation to other signs and symptoms of the disease. Methods Patients with a history of COVID-19 presenting to the clinics of a group of hair experts because of telogen effluvium and/or scalp symptoms, were questioned with regards about their hair signs and symptoms in relation to the severity of COVID-19 and associated symptoms. Results Data from 128 patients were collected. Telogen effluvium was observed in 66.3% of patients and trichodynia in 58.4%. Trichodynia was associated to telogen effluvium in 42.4% of cases and was associated to anosmia and ageusia in 66.1% and 44.1% of cases, respectively. In the majority of patients (62.5%), hair signs and symptoms started within the first month post-COVID-19 diagnosis and in 47.8% of patients after 12 weeks or more. Limitations Recruitment of patient in specialized hair clinics, lack of a control group, and lack of recording of patient comorbidities. Conclusion The severity of the post-viral telogen effluvium observed in patients with a history of COVID-19 infection is influenced by COVID-19 severity. We identified an early onset (<4 weeks) and a late onset (>12 weeks) telogen effluvium.