Post-COVID-19 Alopecia Universalis: Autoimmune Hair Loss and the Challenge of Relapse Management

Alopecia universalis (AU) is the most severe form of alopecia areata (AA), characterized by complete scalp and body hair loss. While post-COVID-19 hair loss is often attributed to telogen effluvium (TE), emerging evidence suggests that COVID-19 may also trigger AU through immune dysregulation, particularly via interferon-gamma (IFN-γ)-mediated inflammation. The chronic and relapsing nature of AU raises challenges in long-term disease management, particularly regarding treatment duration and relapse prevention.

We present a 79-year-old woman with no personal or family history of hair loss who developed sudden-onset AU one month after recovering from COVID-19. Initial treatment with topical and intralesional corticosteroids failed, prompting systemic therapy initiation. Over 10 months of treatment, she achieved significant hair regrowth. However, 3 months after discontinuation, hair loss recurred, reinforcing the relapsing nature of post-COVID-19 AU.

This case uniquely demonstrates the rapid onset and relapsing nature of post-COVID-19 AU, distinguishing it from idiopathic AU and emphasizing the need for modified long-term treatment strategies. While Janus kinase (JAK) inhibitors and other immunomodulatory therapies show promise, the risk of relapse upon treatment discontinuation highlights the need for further research into long-term management strategies and maintenance therapy in post-viral AU.