key: cord-0703259-z03djv8m
authors: Vastarella, Maria; Cantelli, Mariateresa; Nappa, Paola; Fabbrocini, Gabriella; Ocampo‐Garza, Sonia Sofía
title: Black dots in trichoscopy after COVID‐19. Can it be telogen effluvium?
date: 2021-07-12
journal: Dermatol Ther
DOI: 10.1111/dth.15053
sha: 8b2fd4762bc771efa1f5d79016b7038e3b15725d
doc_id: 703259
cord_uid: z03djv8m

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Black dots in trichoscopy after COVID-19. Can it be telogen effluvium?

To the editor, With the growing number of COVID-19 cases, more patients have experienced increased hair loss after SARS-CoV-2 infection. 1 We report a case of a 58-year-old woman with atypical acute telogen effluvium (TE) after recovery from COVID-19.

In February 2021, a patient came to our trichology outpatient clinic because of significant hair loss. The patient was diagnosed with COVID-19 infection in November 2020 by performing a nasopharyngeal swab. The patient developed high fever and severe respiratory distress. She was hospitalized for 45 days and was treated with oxygen, azithromycin, prednisone, and enoxaparin. One month after the discharge she noticed severe diffuse hair loss, with trichodynia, especially in the vertex region. Trichologic examination revealed hair loss affecting the entire scalp with greater involvement of the vertex area ( Figure 1(A) ). A positive pull test was found. Trichoscopy in the frontal area, showed an increasing number of follicular units with one terminal hair, some yellow dots, and few upright regrowing hairs ( Figure 1(B) ). Meanwhile in the vertex area, a significant number of regrowing hairs (up to two or three in the same follicular unit), black dots and perifollicular discoloration were also found ( Figure 1(C) ).

Blood tests excluded vitamin B12, vitamin D, and iron deficiencies, autoimmune diseases, or thyroid dysfunction.

While the trichoscopic picture was compatible with TE in the frontal region, the vertex area showed black dots, typically not found 

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