Characteristics of telogen effluvium in COVID-19 in western Iran (2020).
Study Design
- Type d'étude
- cross-sectional observational study
- Taille de l'échantillon
- 526
- Intervention
- Characteristics of telogen effluvium in COVID-19 in western Iran (2020). None
- Comparateur
- Placebo
- Direction de l'effet
- Neutral
- Risque de biais
- High
Abstract
BACKGROUND: Although COVID-19 pandemic significantly induces mortality, many of the patients who recovered present other medical problems such as alopecias. Telogen effluvium is a common alopecia that is usually related to previous events such as acute febrile diseases, including COVID-19. OBJECTIVE: To evaluate the characteristics of telogen effluvium in COVID-19. METHOD: This cross-sectional study was carried out on 526 patients with documented telogen effluvium that recovered from COVID-19. Demographic data, concurrent alopecia, associated diseases, and COVID-19 severity were recorded. Data were analyzed by appropriate statistical methods. RESULTS: The mean age of the 526 patients (410 females, 116 males) was 30.97 ± 9.592 years, with 7.65 ± 1.739 weeks of mean time of alopecia onset. Vitamin D deficiency (24.3%), androgenetic alopecia (78.2%), and grade III COVID-19 severity were the most common findings. Alopecia onset was significantly earlier in the younger age group, females, in hypothyroidism, and more severe coronavirus infection. Higher grade coronavirus infection was significantly seen in males, higher ages, earlier onset, and androgenic alopecia. STUDY LIMITATIONS: Performing a single-center study and considering limited variables. CONCLUSION: Although Coronavirus 2 infection can be an important factor in telogen effluvium induction, other factors such as associated diseases, drug intake and emotional stress may also be involved. In the cases of early onset of alopecia, concomitant diseases such as hypothyroidism and severe coronavirus infection can occur, thus, the presence of various factors in telogen effluvium induction should be considered.
Full Text
Tables
Table 1
| Variables | Results | |
|---|---|---|
| Mean age of patients (years) | 30.97 ± 9.592 | |
| Mean duration of disease onset (week) | 7.65 ± 1.739 | |
| Sex n (%) | Female | 410 (77.9%) |
| Male | 116 (22.1%) | |
| Associated diseases n (%) | Yes | 181 (34.4%) |
| No | 345 (65.6%) | |
| Type of associated diseases or laboratory findings n (%) | Vitamin D deficiency | 44 (24.3%) |
| Elevated ESR | 38 (21.0%) | |
| Hypothyroidism | 38 (21.0%) | |
| Diabetes | 36 (19.9%) | |
| Iron deficiency anemia | 25 (13.8%) | |
| Smoking n (%) | Yes | 57 (10.8%) |
| No | 469 (89.2%) | |
| Alcohol consumption n (%) | Yes | 43 (8.2%) |
| No | 483 (91.8%) | |
| Concurrent alopecia n (%) | Yes | 147 (27.9%) |
| No | 379 (72.1%) | |
| Type of concurrent alopecia n (%) | Androgenic alopecia | 115 (78.2%) |
| Alopecia areata | 28 (19.0%) | |
| Cicatricial alopecia | 4 (2.7%) | |
| Grading of COVID-19 n (%) | Grade I | 100 (19.0%) |
| Grade II | 150 (28.5%) | |
| Grade III | 193 (36.7%) | |
| Grade IV | 83 (15.8%) | |
| Grade V | 0 (0.0%) | |
| Total number of patients | ||
Table 2
| Variables | Grading of COVID-19 | P value | MDHLOAI | P value | |||
|---|---|---|---|---|---|---|---|
| I | II | III | IV | ||||
| Sex: | |||||||
| Female | 83(20.2%) | 119(29.9%) | 156(38.0%) | 52(12.7%) | 0.03 | 252.3 | 0.001 |
| Male | 17(14.7%) | 31(26.6%) | 37(31.9%) | 31(26.7%) | 303.2 | ||
| ADLF: | |||||||
| Vitamin D deficiency | 6(13.6%) | 11(25.0%) | 21(47.7%) | 6(13.6%) | 0.250 | 15.89 ± 3.384 | 0.000 |
| Hypothyroidism | 7(18.4%) | 8(21.1%) | 16(42.1%) | 7(18.4%) | 13.79 ± 2.361 | ||
| Elevated ESR | 6(15.8%) | 6(15.8%) | 16(42.1%) | 10(26.3%) | 15.26 ± 2.777 | ||
| Diabetes | 3(8.3%) | 9(25.0%) | 16(44.4%) | 8(22.2%) | 15.81 ± 2.703 | ||
| Iron deficiency anemia | 4(16.0%) | 6(24.0%) | 10(40.0%) | 5(20.0%) | 15.52 ± 3.137 | ||
| Concurrent type of alopecia: | |||||||
| Androgenic alopecia | 23(20%) | 33(28.7%) | 39(33.9%) | 20(17.4%) | 0.038 | 15.90 ± 3.115 | 0.568 |
| Alopecia areata | 2(7.1%) | 10(35.7%) | 11 (39.3%) | 5 (17.9%) | 15.71 ± 3.196 | ||
| Cicatricial alopecia | 1(25.0%) | 2(50.0%) | 1(25.0%) | 0(0.0%) | 13.75 ± 3.304 | ||
| Smoking | 7(12.3%) | 18(31.6%) | 19(33.3%) | 13(22.8%) | 0.269 | 259.1 vs 264.0 | 0.816 |
| Addiction | 3(7.0%) | 12(27.9%) | 17(39.5%) | 11(25.6%) | 0.089 | 264.9 vs 248.2 | 0.489 |
| DHLOAI (week) (Mean ± SD) | 8.89 ± 2.039 | 7.98 ± 1.693 | 7.12 ± 1.315 | 6.81 ± 1.273 | 0.000 | ||
| MHL (week) | 9.0(3.0) | 8.0(2) | 7.0(2) | 7.0(2) | 0.000 | ||
| Median (IQR) | |||||||
Table 3
| Variables | Coefficient | S.E | P-value | 95% CI |
|---|---|---|---|---|
| COVID-19 Grade I | 2.749 | 0.825 | 0.001 | (1.13, 4.36) |
| COVID-19 Grade II | 4.778 | 0.834 | 0.000 | (3.14, 6.41) |
| COVID-19 Grade III | 7.542 | 0.885 | 0.000 | (5.8, 9.27) |
| Sex | 0.904 | 0.216 | 0.000 | (0.48, 1.32) |
| Age | 0.140 | 0.012 | 0.000 | (0.11, 0.16) |
| Concurrent types of alopecia | 0.508 | 0.120 | 0.000 | (0.27, 0.74) |
| DHLOAI | -1.819 | 0.221 | 0.000 | (-2.25, -1.38) |
References
- History is repeating itself: probable zoonotic spillover as the cause of the 2019 novel coronavirus epidemic Infez Med, 2020
- Coronavirus Disease 2019 – COVID-19 Clin Microbiol Ver, 2020
- Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-CoV-2) outside of Wuhan, China: retrospective case series BMJ, 2020
- Prolonged and Late-Onset Symptoms of Coronavirus Disease 2019 Open Forum Infect Dis, 2020
- Acute telogen effluvium associated with SARSCoV-2 infection Aust J Gen Pract, 2020
- Telogen effluvium related to post severe SARS-CoV-2 infection: Clinical aspects and our management experience Dermatol Ther, 2021
- Diffuse hair loss: its triggers and management Cleve Clin J Med, 2009
- Drug reactions affecting hair: diagnosis Dermatol Clin, 2007
- Telogen effluvium: a review of literature Cureus, 2020
- Iron status in diffuse telogen hair loss among women Acta Dermatovenerol Croat, 2009
- Telogen effluvium Indian J Dermatol Venereol Leprol, 2013
- SARS-CoV-2 - induced telogen effluvium: a multicentric study J Eur Acad Dermatol Venereol, 2021
- COVID-19 cytokine storm: the interplay between inflammation and coagulation Lancet Respir Med, 2020
- Androgenetic alopecia present in the majority of patients hospitalized COVID19: The “Gabrin sign” J Am Acad Dermatol, 2020
- The natural history of androgenetic alopecia J Cosmet Dermatol, 2005
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