A case of telogen effluvium followed by alopecia areata after SARS-CoV-2 infection.
A case of telogen effluvium followed by alopecia areata after SARS-CoV-2 infection.
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SARS-CoV-2 感染后出现休止期脱发继发斑秃的一例。
DOI：
10.1111/1346-8138.16590
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发表时间：
2023
期刊：
影响因子：
3.1
通讯作者：
Honda T.
中科院分区：
文献类型：
--
作者：
Kageyama R;Ito T;Nakazawa S;Shimauchi T;Fujiyama T;Honda T.
尊敬的编辑，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染，导致冠状病毒病2019（COVID-19），与各种疾病有关，包括自身免疫性疾病，如系统性红斑狼疮，因为它会诱导细胞因子风暴。1作为即时抗病毒反应的关键成分，I型干扰素（IFN）通过自分泌和旁分泌I型IFN受体信号传导对限制病毒复制和传播至关重要。2我们在此报告一例SARS-CoV-2感染后出现斑秃（AA）和休止期脱发（TE）的病例。一位47岁的女性出现咽喉痛、头痛和38.5 ℃的发热。聚合酶链反应检测结果显示，她为SARS-CoV-2阳性，因COVID-19引发的持续高热和重症肺炎入住定点医疗机构。出院后3周，患者头部出现片状脱发，出院后7周转诊至我院（图1a）。皮肤镜观察显示黑点（蓝色箭头）和黄点（黄色箭头;图1b）。通过PBMC的胞浆内染色，与产生IL-4的T细胞（0.64%）相比，外周血单核细胞（PBMC）的流式细胞术分析显示产生IFN-γ的T细胞（10.2%）的频率相对较高（图1c）。在AA改善后不久（COVID-19感染后13周;图1d），患者还经历了整个头皮皮肤的显著毛发脱落（超过200根毛发/天）。皮肤镜观察发现头皮皮肤上有许多毫毛（图1 e）。作为拔毛试验的结果，休止期毛发占约40%。8周后，观察到终末毛发再生，并且过度毛发脱落几乎完全停止。COVID-19的特征是由于过度的细胞因子产生，即所谓的细胞因子风暴，特别是来自浆细胞样树突细胞的IFN，导致轻度至重度呼吸道疾病。这种细胞因子风暴可能导致其他疾病，包括几种自身免疫性疾病。1 IFN-α和IFN-γ也是病毒感染后AA的重要诱导因子。2事实上，有几例病例报告称，在COVID-19发病后1-2个月新发AA。4同样，我们的病例在COVID-19发病后5周出现头皮皮肤片状脱发。当然，没有直接的方法证明COVID-19是AA的原因，但IFN-γ占优势的胞浆内细胞因子平衡可能表明在我们的病例中COVID-19诱导了AA。我们的患者还患有急性TE，其特征在于持续< 6个月的显著毛发脱落，并且是由于毛发周期从生长期到退行期的突然转变以及随后进入休止期所致。在我们的病例中，COVID-19诱导的细胞因子风暴不仅可能导致高烧和严重肺炎，还可能导致从生长期突然切换到退行期，然后是休止期。5随着COVID-19大流行的持续，更多患者可能会经历几种类型的脱发。仔细观察每一种脱发症状，并选择适当的诊断和治疗方法是很重要的。
Dear Editor, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which causes coronavirus disease 2019 (COVID-19), is associated with various conditions, including autoimmune diseases, such as systemic lupus erythematosus, as it induces a cytokine storm. 1 As key components of the immediate antiviral response, type I interferons (IFNs) are crucial for restricting viral replication and spread through autocrine and paracrine type I IFN receptor signaling. 2 We report herein a case of alopecia areata (AA) followed by telogen effluvium (TE) after SARS-CoV-2 infection. A 47-year-old woman experienced sore throat, headache, and fever of 38.5 C. A polymerase chain reaction test indicated that she was positive for SARS-CoV-2, and she was admitted to a designated medical institution for continuous high fever and severe pneumonia induced by COVID-19. Three weeks after discharge, she experienced patchy hair loss on her head, and she was referred to our hospital 7 weeks after discharge (Figure 1a). Dermoscopic observation revealed black dots (blue arrow) and yellow dots (yellow arrow; Figure 1b). Flow cytometric analysis of peripheral blood mononuclear cells (PBMCs) showed a relatively high frequency of IFN-γ-producing T cells (10.2%) when compared to IL-4-producing T cells (0.64%) by the intracytoplasmic staining of the PBMCs (Figure 1c). The patient also experienced significant hair shedding (more than 200 hairs/day) from the whole scalp skin shortly after the AA improved (13 weeks after the COVID-19 infection; Figure 1d). Dermoscopic observation revealed many vellus hairs on the scalp skin (Figure 1e). As a result of the hair plucking test, telogen hair accounted for about 40%. After 8 weeks, terminal hair regrowth was observed, and the excessive hair shedding had almost completely stopped. COVID-19 is characterized by mild to severe respiratory illness due to overzealous cytokine production, the so-called cytokine storm, especially IFNs from plasmacytoid dendritic cells. 3 This cytokine storm can lead to other disorders, including several autoimmune diseases. 1 IFN-α and IFN-γ are also a crucial inducer of AA after viral infections. 2 Indeed, there have been several case reports of the new onset of AA 1–2 months after the onset of COVID-19. 4 Similarly, our case suffered from patchy hair loss on the scalp skin 5 weeks after the onset of COVID-19. Of course, there is no direct way to prove that COVID-19 is the cause of AA, but IFN-γ dominant intracytoplasmic cytokine balance may indicate COVID-19-induced AA in our case. Our patient also suffered from acute TE, which is characterized by significant hair shedding that lasts< 6 months and results from an abrupt shift in the hair cycle from the anagen phase to the catagen phase and subsequent entry into the telogen phase. In our case, the COVID-19-induced cytokine storm may have caused not only high fever and severe pneumonia but also a sudden switch from the anagen to the catagen phase, followed by the telogen phase. 5 As the COVID-19 pandemic continues, more patients may experience several types of hair loss. Careful observation of each hair loss symptom, and appropriate diagnosis and treatment selection are important.