Italian Survey for the Evaluation of the Effects of Coronavirus Disease 2019 (COVID-19) Pandemic on Alopecia Areata Recurrence

Abstract

Introduction: The inflammation storm involved in coronavirus disease 2019 (COVID-19) infection and worsening and the psychological stress derived from current quarantine conditions can affect the course of many skin and scalp conditions. This study examined the possible effects of COVID-19 on alopecia areata (AA) relapse in patients suffering from these scalp conditions during the pandemic. Methods: The study was carried out in the form of an observational cross-sectional type using a questionnaire sent by mail to a cohort of patients affected by AA during the pandemic from March 2020 to October 2020. Results: During the pandemic, AA relapse was reported in 42.5% of the participants who also declared COVID-19 infection, confirmed by nasopharyngeal swab or hematological analysis. The relapse was reported about 2 months later COVID-19 infection (median of 2.14 months) and 74.0% of these participants continue to experience AA symptoms when the survey was proposed. Only 12.5% of participants reported AA relapse in the absence of COVID-19 infection. Conclusions: The present study reported a significant relapse in patients suffering from AA and infected by COVID-19. This phenomenon could be attributed to the inflammation storm typical of COVID-19 infection and the psychological stress derived from quarantine conditions.

Lack of Evidence of COVID-19 Being a Risk Factor of Alopecia Areata: Results of a National Cohort Study in South Korea

“…A South Korea-based previous study that examined the effect of underlying skin disease on COVID-19 susceptibility and mortality also detected no association between skin disease and COVID-19 (32). However, previous studies were mostly based on western society (3)(4)(5)(7)(8)(9), where the racial composition is different from South Korea. Also, the country where the research is based could derive different results.…”

“…the way that COVID-19 itself affects autoimmune pathogenesis of AA (3)(4)(5) or that psychological stress caused by restriction policy against COVID-19 burdens AA (3)(4)(5)(6)(7)(8). However, there is a study that mild to moderate COVID-19 is not associated with worsening AA (9).…”

“…However, there is a study that mild to moderate COVID-19 is not associated with worsening AA (9). This inconsistency might result from limitations of extant literature: relying on cross-sectional studies with restricted study subjects without the control group (4,6,(8)(9)(10), based on a small sample size that is not national representative (3)(4)(5)(6)(7)(8)(9). Furthermore, the study based on South Korea lacks even though South Korea having about 152,000 survivors (1).…”

Association Between Hair Diseases and COVID-19 Pandemic-Related Stress: A Cross-Sectional Study Analysis

“…To the best of our knowledge, there is hardly any previous study on this issue from our country to compare with. However, during this virus outbreak, a number of studies conducted in different countries to explore the pandemic's stress-related hair diseases demonstrate a significant prevalence of hair diseases during this pandemic ( 18 , 37 – 39 ).…”

COVID-19 Pandemic Impact on Severe Alopecia Areata Patients

“…Increasing cases of AA have been previously reported after the COVID-19 outbreak in Turkey [ 12 ]. Rinaldi et al [ 15 ] in a study of 389 patients with AA, in whom 34% had got infected with COVID-19, reported an increased relapse rate of AA among infected patients compared to the noninfected patients (44% vs. 12%). They considered higher rate of AA relapse in the COVID-19 pandemic to be related to the stress of quarantine and the inflammation induced by infection [ 15 ].…”