Black Dots in Trichoscopy After COVID-19: Can It Be Telogen Effluvium?

    July 2021 in “ Dermatologic Therapy ”
    Maria Vastarella, Mariateresa Cantelli, Paola Nappa, Gabriella Fabbrocini, Sonia Sofía Ocampo‐Garza
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    TLDR A woman's hair loss after COVID-19 was likely due to a mix of pressure-induced alopecia and acute telogen effluvium.
    The document reports a case of a 58-year-old woman who experienced significant hair loss after recovering from COVID-19, diagnosed as atypical acute telogen effluvium (TE). Trichoscopy revealed hair loss across the scalp with greater involvement of the vertex area, where black dots and perifollicular discoloration were observed, which are not typically found in TE. The patient's history included using a small pillow for head support during hospitalization, leading to the hypothesis of pressure-induced alopecia (PA) in conjunction with acute TE. Treatment with oral minoxidil, topical clobetasol, and a topical solution with caffeine and peptides resulted in improvement after 3 months. The document suggests that post-COVID-19 alopecia could be a combination of PA and TE, possibly due to tissue ischemia from prolonged pressure and a "cytokine storm" from severe infection. Preventive measures in intensive care units are recommended to reduce the incidence of PA.
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