Dengue-associated telogen effluvium: A report of 14 patients

Descriptive and comparative analysis of mucocutaneous manifestations in patients with dengue fever: A prospective study

BACKGROUND

Dengue is an arbovirosis affecting nearly 4 billion people worldwide. Since 2018, dengue has been re-emerging in Reunion Island. The incidence of mucocutaneous manifestations varies according to the studies and is generally called 'rash'.

OBJECTIVES

To assess the prevalence of different mucocutaneous symptoms and describe the characteristics of patients developing these symptoms and the clinical signs associated with severe dengue.

METHODS

A prospective study was conducted in 2019 at the University Hospital of La Réunion, in patients presenting a positive PCR for dengue. Descriptive analyses were performed. All cases in the prospective study were examined by a dermatologist.

RESULTS

A total of 163 cases were included. The prevalence of mucocutaneous signs was 80.4%. A pruritus was reported in 33.7% cases, an erythematous rash in 29.4% and a mouth involvement including lip, tongue, cheek, angular cheilitis, pharyngitis, mouth ulcer and gingivitis in 31.3%. Most of symptoms appeared in the first days, but some of them could disappear only after the 3rd week. Mucocutaneous signs were not associated with a severe dengue fever (p = 0.54), but ecchymotic purpura was (p = 0.037). In multivariate analysis, skin involvement was associated with flu-like syndrome (headache, pharyngitis, rachis pain) and patient required rehydration but not invasive reanimation.

CONCLUSION

This work confirms the high prevalence of skin symptoms in dengue disease, but also their wide diversity. The mucocutaneous involvement of dengue fever appears to be accompanied by a pronounced flu-like syndrome in people without severity, but careful examination to identify ecchymotic purpura or sign of dehydration in the mucous membranes would better identify cases that may worsen.

Efficacy of QR678 Neo® hair growth factor formulation for the treatment of hair loss in Covid-19-induced persistent Telogen Effluvium-A prospective, clinical, single-blind study

BACKGROUND

Telogen Effluvium (TE) in a post-Covid-19 patient causes excessive shedding of hair. No definite treatment is available till now. Past studies demonstrates that QR678Neo^® has shown promising results in various types of Alopecia.

AIM

In this study, we aim to establish efficacy of QR678 Neo^® hair growth factor formulation administration in Covid-19-induced persistent TE for treatment of hair loss and for hair regrowth.

MATERIAL & METHOD

Twenty adult patients (all females) presenting with persistent TE starting few weeks after recovery from Covid-19 infection, and continuing beyond 6 months were included for the study. A 1.5 mL solution of QR678 Neo^® hair growth factor formulation was administered in the scalp per session. A total of 8 sessions (one session every 4 weeks) were done. The results were assessed at the baseline, after 4thsession, and 1 month after 8th session.

RESULTS

Most of the patients showed significant reduction in hair fall; 89% patients showed excellent hair growth. Global photographic assessment score showed marked improvement, which maintained even post therapy. Videomicroscopic assessment showed increase in the hair count (mean =29.32) after 8th session, that further improved even post therapy. The subjective assessment scores for overall hair growth, appearance of hair, reduction in visibility of the scalp, and hair loss were 4, 4.5, 4.25, and 5, respectively.

CONCLUSION

Management of Covid-19-induced persistent Telogen Effluvium has been unclear and futile so far. Intra-dermal administration of QR678 Neo^® hair growth factor formulation in the scalp, reduces hair fall, improves hair regrowth, and increases the hair density.

COVID-19 infection is a major cause of acute telogen effluvium

Background

Acute telogen effluvium is a non-scaring hair loss, usually occurs 3 months after the stressful event that causes hair shedding, and lasts up to 6 months. It can be associated with post COVID-19 infection.

Objective

To study the possible effects of COVID-19 on the hair growth cycle and the relationship between COVID-19 and acute telogen effluvium.

Patients and methods

This is an observational cross-sectional study that had been conducted during the period from September 2020 to March 2021 years. Thirty-nine patients with post COVID-19 hair loss are confirmed by polymerase chain reaction (PCR) or antibody testing. Hair pull test was carried out to confirm the diagnosis and severity of telogen effluvium.

Results

Thirty-nine patients were evaluated; their ages ranged from 22 to 67 years with a mean and SD of 41.3 ± 11.6 years with 36 (92.3%) females and 3 (7.69%) males.

All patients with a diagnosis of ATE were enrolled in this study and had a laboratory-confirmed diagnosis of prior SARS-CoV-2 infection; 15 (38.46%) patients reported mild symptoms, 24 (61.53%) patients presented with moderate disease, and no patient required hospitalization. They all experienced excessive hair loss within 2–3 months after infection. Pull tests were strongly positive (> 10–50% with a mean of 35% of pulled hair away from scalp).

Conclusion

COVID-19 infection is now a frequent and a common cause of acute telogen effluvium. Hence, clinicians should be aware about the relation between this infection and this pattern of hair loss. Drugs that have been used for the treatment of COVID-19 were excluded as a cause of acute telogen effluvium.

Prominent Cutaneous Manifestation of COVID-19: A Case Report

Extrapulmonary signs of coronavirus disease are becoming an important tool for patient diagnosis; this is particularly true for skin manifestations as they are visible to both the patient and physician. In this case report, the authors describe a case in which cutaneous manifestations were the most noticeable and prominent symptom in a patient with coronavirus disease.

Telogen Effluvium - a review of the science and current obstacles

Telogen effluvium (TE) is a common cause of diffuse non-scarring hair loss that is usually precipitated by physiological stress such as childbirth or sudden weight loss. Despite its high rate of remission, this phenomenon of sudden excessive hair loss can be very worrisome and upsetting for affected individuals and may significantly impact their quality of life. Due to the multifactorial causes and precipitants of TE, it is often challenging to diagnose and manage. Further, the mechanisms through which physiological stress influences the human hair cycle is unknown, and there are no targeted treatments for the management of TE. This review will describe the approach in making a diagnosis of TE, summarize the latest developments made in understanding the mechanisms of TE, outline the treatments tried, and recommend ways for advancing the study of this dermatological condition.

The necessity of holistic approach to treatment of telogen hair loss associated with iron deficiency in women

The relationship between disorders of iron metabolism and alopecia, in particular telogen hair loss (THL), remains poorly understood and requires further research. Goal. To assess changes in the dynamics of growth and hair condition in women with an iron deficiency state during systemic therapy with iron supplements in combination with and without physiotherapy. Methods. An open-label, randomized, comparative interventional study with a duration of 6 months included 26 female aged 19 to 54 years (38.8 8.9 years) with complaints of hair loss, changes in their structure, dryness and / or hair brittleness; with preserved menstrual cycle and mild iron deficiency anemia (IDA, Hb 101120 g/l). Trichoscopy and phototrichogram were performed with processing of the results in the TrichoScienceProv1.1 program. The changes in the dynamics of hair growth and condition were assessed against the background of the use of iron supplements in combination with physiotherapy and without physiotherapy. Pulsed alternating sinusoidal current of high frequency, high voltage and low strength was chosen as a physiotherapeutic method for the treatment of THL. Results. Against the background of the therapy, an increase in the Hb level (p 0.001) and a positive dynamics of trichological parameters in all patients were noted, the severity of which was higher when the therapy with iron supplements was combined with physiotherapy. Conclusion. Our findings confirm that the complex treatment of patients with telogen alopecia on the background of an iron deficiency state may achieve positive dynamics of trichological indicators.

The necessity of holistic approach to treatment of telogen hair loss associated with iron deficiency in women

The relationship between disorders of iron metabolism and alopecia, in particular telogen hair loss (THL), remains poorly understood and requires further research. Goal. To assess changes in the dynamics of growth and hair condition in women with an iron deficiency state during systemic therapy with iron supplements in combination with and without physiotherapy. Methods. An open-label, randomized, comparative interventional study with a duration of 6 months included 26 female aged 19 to 54 years (38.8 8.9 years) with complaints of hair loss, changes in their structure, dryness and / or hair brittleness; with preserved menstrual cycle and mild iron deficiency anemia (IDA, Hb 101120 g/l). Trichoscopy and phototrichogram were performed with processing of the results in the TrichoScienceProv1.1 program. The changes in the dynamics of hair growth and condition were assessed against the background of the use of iron supplements in combination with physiotherapy and without physiotherapy. Pulsed alternating sinusoidal current of high frequency, high voltage and low strength was chosen as a physiotherapeutic method for the treatment of THL. Results. Against the background of the therapy, an increase in the Hb level (p 0.001) and a positive dynamics of trichological parameters in all patients were noted, the severity of which was higher when the therapy with iron supplements was combined with physiotherapy. Conclusion. Our findings confirm that the complex treatment of patients with telogen alopecia on the background of an iron deficiency state may achieve positive dynamics of trichological indicators.

Telogen effluvium related to post severe Sars-Cov-2 infection: Clinical aspects and our management experience

Telogen effluvium (TE) is one of the most common form of hair loss in women. Many triggers have been identified, as stress, drugs, trauma, endocrine disease, nutritional deficiencies, and febrile states. We report three cases of TE occurred after severe Sars‐Cov‐2 infection and provide our clinical management, according to Sars‐Cov‐2 hygiene measures. Only one case report has been found in the literature associating anagen effluvium during severe Sars‐Cov‐2 infection. Other studies reported the exacerbation of a preexisting TE, correlated to the stress of lockdown. In our cases, patients never had a TE diagnosis before and did not report previous evident hair loss. TE can be associated with post severe Sars‐Cov‐2 infection. From our revision of the literature, this is the first case‐series describing TE in post severe Sars‐Cov‐2 patients. Further studies are needed to evaluate the relationship between TE and Sars‐Cov‐2 infection.

Assessment of Prolonged Dengue Virus Infection in Dermal Fibroblasts and Hair-Follicle Dermal Papilla Cells

Dengue virus (DENV)-mediated hair loss is one of the post-dengue fatigue syndromes and its pathophysiology remains unknown. Whether long-term or persistent infection with DENV in the scalp results in hair loss is unclear. In this study, we cultured human dermal fibroblasts (WS1 cells) and primary human hair-follicle dermal papilla cells (HFDPCs) in the long term with DENV-2 infection. The production of virion, the expression of inflammatory and anti-virus genes, and their signaling transduction activity in the infected cells were analyzed. DENV-2 NS3 protein and DENV-2 5′ UTR RNA were detected in fibroblasts and HFDPCs that were subjected to long-term infection with DENV-2 for 33 days. A significant amount of DENV-2 virion was produced by both WS1 cells and HFDPCs in the first two days of acute infection. The virion was also detected in WS1 cells that were infected in the long term, but HFDPCs failed to produce DENV-2 after long-term culture. Type I and type III interferons, and inflammatory cytokines were highly expressed in the acute phase of DENV infection in HFPDC and WS1 cells. However, in the long-term cultured cells, modest levels of anti-viral protein genes were expressed and we observed reduced signaling activity, which was correlated with the level of virus production changes. Long-term infection of DENV-2 downregulated the expression of hair growth regulatory factors, such as Rip1, Wnt1, and Wnt4. This in vitro study shows that the long-term infection with DENV-2 in dermal fibroblasts and dermal papilla cells may be involved with the prolonged-DENV-infection-mediated hair loss of post-dengue fatigue syndrome. However, direct evidence for viral replication in the human hair of a dengue victim or animal infection model is required.

Dengue Virus Infects Primary Human Hair Follicle Dermal Papilla Cells

During the epidemic of the dengue virus (DENV) infection in Taiwan in 2014 and 2015, we observed an abnormally high frequency of increased scalp hair shedding in infected individuals that could not be explained by telogen effluvium. In this study, the mechanism of hair loss caused by DENV was explored. Human hair follicle dermal papilla cells (HFDPCs) are essential for hair follicle morphogenesis and cycling. Thus, we established an in vitro DENV infection model in HFDPCs. On immunofluorescence analysis, HFDPCs that were susceptible to DENV infection responded to type I interferon (IFN) treatment, and the cells showed antibody-dependent enhancement (ADE) effect. The expression of the pro-inflammatory cytokines, interleukin 6 (IL-6), and tumor necrosis factor-alpha (TNF-α), revealed an inflammatory response in DENV-infected HFDPCs. In particular, DENV infection impaired cell viability, and it activated caspase-associated cell death signaling in HFDPCs. In conclusion, our data indicate that direct infection with DENV causes inflammation and cell death in HFDPCs, which is involved in the mechanisms of hair loss after DENV infection. The knowledge of DENV infection in an immune-privileged tissue, such as hair follicles, may suggest their use for further studies on post-dengue fatigue syndrome (PDFS).