In addition to health consequences, perhaps the most visible effects of COVID-19 relate to mask-wearing, frequent hand-washing/sanitizing and fatigue/emotional stress. But biological connections between the virus, skin rashes and hair loss also have emerged.
Mask-wearing obviously can cause friction irritation, skin redness and 'maskne.' Hand-washing, while critical, dries skin, causing cumulative irritation, itch, a cracked and compromised skin barrier, etc. Emotional toll and fatigue, whether from social isolation, over-use of devices, loss of employment, health concerns for self/loved ones—and lack of sleep from worrying about all of the above—takes many forms, up to and including under-eye circles and bags, lackluster skin and even skin aging.
The New York Times recently reported the effects of stress from the coronavirus are causing individuals to lose their hair. The firm cited a survey from July out of the Indiana University School of Medicine wherein of the 1,567 members of a COVID-19 survival group, some 423 reported unusual hair loss. American actress Alyssa Milano recently came out with her story of COVID-19 survival and resulting hair loss, too, which gained mainstream media attention.
As noted, biological connections between the virus, skin and hair also have emerged. In skin care, these present future targets for personal care product development, whereas in hair, androgenic alopecia may provide a clue to possible COVID-19 treatment. (Of course, stress-induced hair loss poses another opportunity.)
Following are just six examples of what science has uncovered. Clearly, the body of evidence will continue to grow as the coronavirus is researched in greater depth.
'COVID-19 Fingers and Toes': Characteristic Skin Rashes
Bataille, V., Visconti, A., ... Falchi, M., et al.; MedRxiv; available at: https://doi.org/10.1101/2020.07.10.20150656
Work published by researchers at King's College London proposes the diagnostic potential of "COVID-19 fingers and toes," presenting with reddish and purplish bumps or rashes. These can occur even in the absence of other symptoms and could be used to identify carriers of the virus. This proposal is based on data collected from 336,000 users of the "COVID Symptom Study" app in the UK. Of these, 8.8% reporting positive coronavirus swab tests also reported skin rashes as part of their symptoms, compared with 5.4% of those reporting negative test results.
In relation, an online survey was devised to collect data and photographs. Nearly 12,000 individuals with both skin rashes and suspected or confirmed cases of COVID-19 participated. Particularly sought were photographs from people of color, who the authors report are underrepresented in dermatology resources. Of the respondents testing positive for the coronavirus, 17% reported a rash as the first symptom; for one in five people (21%), the rash was their only symptom.
In relation, these authors note that rashes associated with COVID-19 fall into three categories: hive-type (urticaria); "prickly heat" or chickenpox-type; and chilblains on fingers and toes. Lead author and dermatologist Veronique Bataille, M.D., Ph.D., stated, "Many viral infections can affect the skin, so it’s not surprising that we are seeing these rashes in COVID-19. However, it is important that people know that in some cases, a rash may be the first or only symptom of the disease."
COVID-19-associated Dermatologic Manifestations
Freeman, E.E., McMahon, D.E., ... Fox, L.P., et al.; J Amer Acad Dermatol; https://doi.org/10.1016/j.jaad.2020.06.1016
A study published in the Journal of the American Academy of Dermatology sought to characterize various cutaneous manifestations of COVID-19 to elucidate its pathophysiology. Here, in 171 confirmed cases of COVID-19—excluding any subjects having medication-induced skin conditions or historic inflammatory conditions—the most common morphologies presented in patients were: morbilliform (a measle-like rash, 22%), pernio-like (an inflammatory vascular response on acral skin, 18%), urticarial (itchy, red welts or hives, 16%), macular erythema (also known as roseola or baby measles, 13%), vesicular (blister-like sacs on skin, 11%), papulosquamous (papules and scales or plaques on skin, 9.9%) and retiform purpura (reticulate eruptions of vascular origin, 6.4%).
SARS-CoV-2, Skin and Immunology: What We Know So Far
Novak, N., Peng, W., ... Catala, A., et al.; Euro J Allergy and Clin Immunology; https://doi.org/10.1111/all.14498
This review summarizes known manifestations of various skin lesions and lesions of the vascular system in some SARS‐CoV‐2‐positive patients. According to the article abstract, vesicular, urticarial and maculopapular eruptions and livedo (a net-like pattern of reddish-blue skin discoloration), necrosis and other vasculitis forms have been reported most frequently in association with COVID-19. This overview of these conditions also summarizes current knowledge of immunologic, clinical and histologic features of virus‐ and drug‐induced lesions of the skin and changes to the vascular system in hopes of transferring this knowledge to potential mechanisms induced by SARS‐CoV‐2.
Hair Loss, Androgens and COVID-19 Severity
Wambier, C.G., McCoy, J., Gold, M.H.and Kovacevic, M.; Société Tunisienne de Dermatologie et de Vénéréologie; doi: 10.1111/jocd.13443
The present paper, pending publication, describes the high frequency of male pattern hair loss observed among admitted COVID-19 patients. It cites previous work outlining how during the COVID-19 pandemic, a significant difference in the rate of severe cases between adult females and adult males (42% vs 58%) has been observed. These authors suggest that androgen expression in cases of adrogenic alopecia might be a clue to COVID-19 severity.
Male Balding as a Risk for Severe COVID-19
Lee, J., Yousaf, A., Fang, W. and Kolodney, M.S.; Journal of the American Academy of Dermatology; doi: https://doi.org/10.1016/j.jaad.2020.07.062
Building off of Wambier, et al. (above), the present authors examined the severity of hair loss in a controlled study of 1,941 hospitalized male patients testing positive for COVID-19. Their results showed the number of COVID-19 positive cases trended higher with increasing self-reports of baldness. As such, the authors point to the potential association between severe cases of androgenic alopecia and risk of COVID-19.
Racial Variants in COVID-19 Deaths: Associations with Androgen Receptor Genetic Variants?
McCoy, J., Wambier, C.G., ... Goren, A., et al.; J Cosmet Dermatol; doi: 10.1111/jocd.13455
According to these authors, as COVID-19 spreads to more Americans, a racial disparity in the number of deaths has emerged. This racial difference is similarly observed in conditions influenced by sensitivity to androgens, such as prostate cancer and androgenetic alopecia hair loss, these authors report. They add that gender and age variances in the severity of COVID‐19 also have been reported and might be explained by an androgen‐mediated mechanism. These authors note they are planning a study to measure CAG (cytosine, adenine and guanine) length polymorphisms in patients hospitalized with COVID-19, as they believe, "the similarities in racial and gender bias to other androgen-mediated conditions are noteworthy."