As the duration of telogen is ∼3 to 4 months, the shedding usually starts at this time. The cytokines released due to the infection/fever, prematurely push the follicles into catagen and then into telogen. After a fever-causing infection, the effluvium usually starts 3 to 4 months after the inciting infection. The effluvium caused post the infection with SARS COV2 could be explained by the physiologic response of the follicles to the stress of the infection. Or the so-called cytokine storm is the cause of multi-organ injury. Release of cytokines such as tumor necrosis factor-α (TNF α), granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-1 (IL-1), interleukin-6 (IL-6), IL-1β, IL-8, IL-12 and interferon (IFN)-γ The more severe late stage is marked by an immune response by the infected host cells with the recruitment of T lymphocytes, monocytes, and neutrophil recruitment. Viral replication results in direct tissue damage in the early phase which is followed by a more severe late phase in some patients. Primarily, it impacts the lungs but affects most of the organs including the skin. Once the virus gains entry into the host, the spike receptor-binding domain (RBD) allows the binding to the angiotensin-converting enzyme 2 (ACE2) receptor in the lungs and other tissues. The SARS-CoV-2 virus spreads mainly via respiratory droplet transmission and through the air (airborne transmission) or fomites. Understanding Pathogenesis of COVID-19 Infection Moreover, it tries to identify if the hair fall is due in addition to a combination of various factors such as cytokines, medications used during the treatment (antivirals, antibiotics, steroids, anticoagulants, etc.), the psychological impact of the infection, and local restrictions/quarantine and ambient stress of the pandemic. This review attempts to understand if the mechanism of effluvium post-COVID-19 is similar to that seen with any other infections, as a response to stress created by febrile episodes or whether COVID-19 infection has a direct impact on hair follicles. Literature review in terms of the impact of COVID-19 infection on the hair follicle reveals hair loss caused during and post-recovery, majorly manifesting as TE. Hair fall (telogen effluvium ) after bacterial or viral or protozoal infections is not a new phenomenon and was also reported after the 1918 influenza epidemic. Moreover, since the start of the ongoing pandemic, the authors who have a practice dedicated to hair restoration, have been approached by a large number of patients presenting with effluvium most of whom suffered COVID-19 infection but there were a few who did not have any history of infection. More than a year into the pandemic and we have learned to expect the unexpected and are still uncovering different ways the SARS-COV2 virus is affecting humans. The story that began in the city of Wuhan of the Hubei province of China has spread to most parts of the world.Īs per the World Health Organization (WHO), the cumulative number of cases reported globally is now over 190 million and the number of deaths exceeded 4 million as of July 2021. This novel coronavirus (CoV) is a positive-stranded RNA virus with a crown-like appearance caused by spike glycoproteins on the envelope designated as severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2). Coronavirus disease 19 (COVID-19) is the third documented spill-over of an animal coronavirus to humans and can be regarded as a systemic viral illness based on its involvement in multiple major organ systems.
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