Refractory Alopecia Areata Flare Developing 1-2 weeks After COVID Vaccination — Donovan Hair Clinic

It is increasingly recognized that vaccines may carry a small risk of flaring or causing alopecia areata. In many studies, alopecia areata can occur after the first, second or third dose but the second dose appears most common in studies to date. There are two patterns of flare – one occurs within 2 weeks of the vaccine and the other occurs within 7-8 weeks. Data to date support a notion that the type of alopecia areata can often be more severe with vaccine induced alopecia areata. Whether it’s truly more refractory to treatment is not clear but there is some suggestion it could be.


Here authors present two patients with a prior history of alopecia areata who flared within 2 weeks of their vaccine


Case 1

The first case was a 29 year old male who developed alopecia areata patches 1 week after his second dose of AstraZeneca vaccination. He progressed from SALT Score 13 to SALT score 82.

He had a history of AA, and had been treated with oral steroid in the past and was stable for 7 months.  He was treated with oral steroids again but it had not been successful after 2 months of follow up.


Case 2

The second case was a 26 year old female with diffuse hair loss involving the scalp, eyebrows, eyelashes, and body hairs after two doses of Pfizer-BioNTech vaccination. She too was previously diagnosed with alopecia areata and was treated in the past with 4 courses of pulsed steroid therapy and had near complete remission of her AA. Two weeks after the second dose of Pfizer-BioNTech vaccination, diffuse hair loss occurred and progressed to alopecia universalis.  She was retreated with pulse steroid therapy again but had not response to treatment despite another four courses of treatment.




There is growing evidence that vaccines can trigger alopecia areata flares in patients with prior AA and vaccines can trigger AA in patients without past alopecia areata. The exact risk is unclear although one study by Babadjouni et al did suggest a 6 % risk of flare in stable patients with alopecia areata on JAK inhibitors. An uncontrolled study by Nguyen and Tosti reported 68 % of surveyed patients with AA had symptoms after the vaccine. 51 % of those patients had a new onset AA diagnosis and 49 % had a flare of existing alopecia areata. This was a survey based study recruiting from an alopecia areata social media site so it does have limitations in how those numbers are interpretted.

More studies are needed to better define the risk and to determine whether patients with vaccine induced AA are truly more refractory to therapy. It does seem that vaccine induced AA is more likely to present with more widespread disease than spontaneous AA or even COVID AA but again more studies are needed to prove that too.


Chen C-H et al. Intractable alopecia areata following the second dose of COVID-19 vaccination: Report of two cases. Dermatol Ther. 2022 Sep;35(9):e15689.

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