Telogen effluvium and COVID-19: a cross-sectional study

A. Aldahish, R. Vasudevan, H. Salem, A. Alqahtani, S. AlQasim, A. Alqhatani, M. Al Shahrani, L. Al Mohsen, M. Hajla, D. Calina, J. Sharifi-Rad

Department of Pharmacology, King Khalid University, Abha, Kingdom of Saudi Arabia. adahesh@kku.edu.sa

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• Infectious Diseases

OBJECTIVE: COVID-19 is a febrile infectious disease caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). This virus affects several organs, including the skin. Acute telogen effluvium (TE) is a non-scarring hair loss characterized by diffuse hair shedding that begins three months after a stressful event and can last up to six months. COVID-19 infection is one of these potential stressors. Recently, there has been a reported link between increased scalp hair shedding and post-infection patients during the COVID-19 outbreak. The present work aimed to study the possible effects of COVID-19 on hair and the relationship between COVID-19 and TE and to assess the level of awareness about TE in the Asir region of Saudi Arabia.

SUBJECTS AND METHODS: A questionnaire-based cross-sectional study was conducted using a pre-validated questionnaire. The study involved 561 participants from the Asir region of Saudi Arabia. Eligible participants were individuals from the Asir region who were 20 years of age or older, had previously contracted COVID-19 and had no history of TE before infection. All statistical methods used were two-tailed with an alpha level of 0.05, considering significance if the p-value was lower than or equal to 0.05.

RESULTS: A total of 1,000 eligible participants completed the study questionnaire. The mean age was 32.5 ± 13.9 years, and 494 (88.1%) participants were females. In addition, 558 (99.5%) of the study participants had received the COVID-19 vaccine. A total of 411 (73.3%) participants experienced an increase in hair loss after COVID-19 infection, and 171 (30.5%) began suffering from pain when combing their hair. In addition, 182 participants (32.4%) had a family history of TE. Only 109 (10.9%) participants had a good awareness level about TE, while 452 (80.6%) had an overall poor awareness level. There was a significant relationship between the level of awareness and age, where 23.9% of the participants aged 20-29 years had a good level of awareness vs. 16.1% of others aged 40 years or older (p = 0.041). Moreover, 26.9% of participants with a family history of TE had a good awareness of TE, vs. 15.8% of those with no family history of TE (p = 0.002). In addition, significant correlations were found between increased hair loss post-COVID-19 infection and female gender (77.3% vs. 43.3%; p = 0.001) as well as suffering from pain when combing hair (86.5% vs. 65.5%; p = 0.001).

CONCLUSIONS: In our study, the incidence of TE was highly related to COVID-19 infections among both sexes. However, the incidence was greater among the female population. The awareness level toward post-COVID-19 TE was poor among most of the participants in our study.

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