Hair

The Red Bands of Telogen Effluvium — Donovan Hair Clinic


4 New Cases of Red Nail Bands in Association with TE

Hair and nails are closely related and abnormal nail findings can be identified in many hair loss conditions. For example. Telogen effluvium is well known to be a complication of COVID 19 infection. Patients present with hair loss 4-12 weeks after infection. A variety of nail changes are now understood to be part of COVID19 including Beau’s lines, red half-moon nail sign, onychomadesis and distal orange discoloration,

The authors of a new study report 4 cases with nail changes showing red bands in the setting of post-COVID-19 telogen effluvium. The patients were 4 female patients with ages ranging from 30 to 39 years. They presented with telogen effluvium starting 8, 11, 12 and 14 weeks after COVID 19. Hair loss had been occuring for 2–4 weeks duration prior to presenting for medical advice. Although 2 of the patients required hospitalization, none of the patients had any associated comorbidities.

Nail examination showed a pattern of nail changes in the form of red bands in multiple digits in all 4 patients. One patient had noticed these nail changes herself about 4 weeks after the start of the COVID-19 illness, while the other three were unaware of these subtle nail findings.

Comment.

I found this report to be really interesting. It reminds us again of how many different manifestations exist with the COVID 19 infection. The cause of these nail changes is not completely understood. It has been proposed by some that microvascular injury or a procoagulant state secondary to inflammation might be the reason.

This is not the first report of these red nail bands. Neri et al reported a patient developing red bands starting two weeks after symptoms onset. The bands persisted during one month of follow up and became wider.

It’s important to recognize this sign. Many patient present to clinic with telogen effluvium and sometimes the cause of a person’s shedding is a mystery. This is the case when blood tests come back normal and no clear triggers are found. In the COVID pandemic era, we always need to consider the possibility that the patient sitting in front of us had COVID 19 infection in the past few weeks and months. Many patients of course are asymptomatic and can’t imagine this would even be a possibility.

The presence of red bands in the nail could be a helpful sign for us to indicate prior COVID infection. More studies are needed to determine how long these bands last and how sensitive and specific they are for COVID 19 infection.

REFERENCE

Thakur et al. Red nail bands in conjunction with telogen effluvium as a post-COVID-19 phenomenon. Australas J Dermatol. 2022 Feb;63(1):141-142.

Neri I, Guglielmo A, Virdi A et al. The red half-moon nail sign: a novel manifestation of coronavirus infection. J. Eur. Acad. Dermatol. Venereol. 2020; 34: e663–e5.



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