Late unexpected consequences of COVID-19 infection in survivors of acute hypoxic respiratory failure

In the literature, the onset of alopecia occurring after multi- system illnesses, psychological distress, fever and intensive care unit (ICU) admission is described. During the COVID-19 pandemic some studies reported patients suffering from androgenic alopecia and alopecia areata. We conducted a prospective single-centre study from May to July 2020. All 38 patients enrolled were COVID-19 survivors of severe hypoxic respiratory failure who had been admitted to respiratory intermediate ICU needing respiratory support. They were all re- evaluated via a dermatologic assessment as they were all complaining to their general physicians of persistent alopecia. Within 3 months after discharge 71% of our patients developed telogen effluvium (TE) alopecia phenotype. The pathophysiologic mechanisms responsible for its onset may be prioritised as follows: (i) severe prolonged hypoxia; (ii) increased androgen receptor related pathway; (iii) drugs used during admission; (iv) stress; and (v) autoimmune disease.