I read with interest a report in the ophthalmology literature of a 7-year-old boy who developed left upper eyelash loss 9 weeks after coronavirus disease 2019 infection.
The patient had a COVID 19 infection marked by low-grade fever and fatigue. He had been treated with paracetamol, also known as acetaminophen. He recovered from his illness within 1 week without any complications. It was only at the time point 8 weeks after his recovery that he developed hair loss on the left upper eyelashes. The right eyelashes were unaffected and there was no hair loss any where else.
The authors point out that the “hair pull test was negative when implied to his scalp hair, indicating that alopecia areata did not exist.” The authors found that a gentle pull to the left upper eyelashes lead to a positive pull test. Visual and eye examinations were normal. There were no signs of trichotillomania like black dots or broken hairs. All blood tests were normal.
The patient experienced regrowth of hair 2 months later 2 months later.
I don’t think this is a case of telogen effluvium as the authors propose. I think the case is more likely that of an unusual alopecia areata.
The authors correctly point on that causes of hair loss in children include TTM, alopecia areata, tinea capitis and telogen effluvium.
The authors felt confident that they had excluded alopecia areata by virtue of the fact they could not see alopecia areata on the scalp.
The most likely post COVID hair loss conditions are anagen effluvium, telogen effluvium and alopecia areata. The first two tend to be symmetrical and the later tends to be asymmetrical in the early stages (although can be symmetrical in advanced stages).
It seems that alopecia areata or an alopecia areata – like hair loss condition is more likely with unilateral loss in a patient where trichotillomania has confidently been ruled out.
Eser NA et al. Unilateral Ciliary Madarosis in a Child After Coronavirus Disease 2019 (COVID-19) Infection. Ophthalmic Plast Reconstr Surg. 2022 Oct 20.