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

Abstract

Background: The cutaneous manifestations of COVID-19 may be useful disease markers and prognostic indicators. Recently, postinfectious 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 the 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 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 the patients and trichodynia in 58.4%. Trichodynia was associated with telogen effluvium in 42.4% of the cases and anosmia and ageusia in 66.1% and 44.1% of the cases, respectively. In majority (62.5%) of the patients, the hair signs and symptoms started within the first month after COVID-19 diagnosis, and in 47.8% of the patients, these started after 12 weeks or more.

Limitations: The recruitment of patients in specialized hair clinics, lack of a control group, and lack of recording of patient comorbidities.

Conclusion: The severity of postviral telogen effluvium observed in patients with a history of COVID-19 infection may be influenced by COVID-19 severity. We identified early-onset (<4 weeks) and late-onset (>12 weeks) telogen effluvium.

Keywords: COVID-19; OR, odds ratios; SARS-CoV-2; TE, telogen effluvium; TR, trichodynia; hair loss; hair shedding; multicentric study; scalp allodynia; telogen effluvium; trichodynia.

Fig 1

The first bar plot shows the different prevalence of asthenia, headache, anosmia, and dysgeusia among the 3 groups studied. The χ² test yielded significant P values (P < .05) for all the displayed variables. The second box plot illustrates the distribution of the 3 quantitative variables common to the groups studied. Outliers' values are displayed as stars. The COVID-19 duration was significantly shorter in the TR⁺ group (P < .05). TE⁺/TR⁻, Telogen effluvium without trichodynia; TE⁺/TR⁺, telogen effluvium with trichodynia; TR⁺/TE⁻, trichodynia without telogen effluvium; TR⁺/TE⁺, trichodynia with telogen effluvium.

Fig 2

The box plot of TR/TE latency and disease duration among the 2 group clusters compared (TE⁺ vs TE⁺/TR⁺ and TR⁺ vs TR⁺/TE⁺) shows the difference in latency (P < .05), whereas disease durations did not differ significantly. TE⁺/TR⁻, Telogen effluvium without trichodynia; TE⁺/TR⁺, telogen effluvium with trichodynia; TR⁺/TE⁻, trichodynia without telogen effluvium; TR⁺/TE⁺, trichodynia with telogen effluvium.

Fig 3

The bar plot shows the distribution of disease severity among the groups studied. TE⁺, Telogen effluvium alone; TE⁺/TR⁺, telogen effluvium with trichodynia; TR⁺, trichodynia alone.

Fig 4

Graphical representation of the multivariate logistic regression. The arrows indicate the group whose probability is predicted. In a binary response model, the adjusted OR is the estimate of the OR between the 2 events, where the effects of other variables are held constant. OR, Odds ratio; TE⁺, telogen effluvium alone; TE⁺/TR⁺, telogen effluvium with trichodynia; TR⁺, trichodynia alone.