Spontaneous complete resolution of alopecia totalis post SARS-CoV-2 infection

Abstract

COVID-19, linked to the infection with SARS-CoV-2, has been associated with a plethora of cutaneous manifestations with an estimated prevalence ranging from 0.2% to 20% according to various studies.1 Review articles and case series have documented several types of skin eruptions including erythematous macules and papules, urticarial, papulosquamous, varicelliform, morbilliform, purpuric, livedo reticularis–like, retiform purpura, petechial, and pernio-like acro-ischemic lesions.1 Hair and nail involvement has additionally been reported such as telogen effluvium and leukonychia.

Case Details

Disease Location

Hair

Personal Characteristics

32-year-old female

Clinical Characteristics

The patient had had alopecia totalis for 13 years. She had received topical, oral, intravenous, and intralesional corticosteroids; topical minoxidil 5% solution; and oral isoprinosine, all of which resulted in poor response. Partial hair regrowth was observed with hydroxychloroquine and methotrexate. Finally, the patient was treated with tofacitinib alone with a 15-mg daily dose. She discontinued the medication in the early days of the covid-19 pandemic. The patient tested positive for sars-cov-2. She regressed shortly afterward with a recurrence of her alopecia totalis and lost all her scalp hair over a 3-month period.

Remission Characteristics

3 months after recovering from covid-19 and while she had been off tofacitinib for 10 months, a spontaneous total hair regrowth started to be observed, and satisfying results were obtained approximately a year later

Treatment & Mechanisms

Proposed Remission Mechanisms

Sars-cov-2 inhibits the autoimmune reaction against hair follicles by antigenic competition

Clinical Treatment

Tofacitinib