Assessing the risk of pediatric alopecia areata after COVID-19 infection: A population-level study

Summary: Abstract Body: COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been linked to various immune-related dermatologic conditions, including alopecia areata (AA). Recent studies highlight new onset, recurrence, or exacerbation of AA after COVID-19 infection. However, reports in pediatric populations are limited. This study aimed to investigate the potential association between COVID-19 infection and the development of AA in pediatric patients. This population-level retrospective cohort study utilized the TriNetX US Collaborative Network to analyze pediatric patients (age 0-18) with a confirmed SARS-CoV-2 infection, identified through the ICD-10-CM Diagnosis Code U07.1. The control cohort comprised pediatric patients (age 0-18) without a COVID-19 diagnosis. Separate analyses were conducted for male and female cohorts to evaluate potential sex-based differences in associations. The two cohorts were matched 1:1 using propensity scores, adjusting for baseline demographics before assessing the development of AA. Female pediatric patients with reported COVID-19 infection conferred a significantly higher risk of AA compared to those without reported infection (HR [95% CI] = 0.455 [0.298-0.696]). In contrast, no significant association was observed between COVID-19 infection and the risk of developing AA in male pediatric patients (HR [95% CI] = 0.771 [0.467-1.273]). The prolonged effects of COVID-19, particularly related to autoimmune disease, are not yet fully elucidated. Our study suggests that there is an increased risk of alopecia areata in female children after COVID-19. Possible mechanisms include molecular mimicry between SARS-CoV-2 and hair follicle autoantigens, cytokine shifting, and bystander activation, but further studies are needed. This retrospective data may help identify pediatric patients at risk of developing or exacerbating AA, ultimately enhancing clinical understanding of this complex, multifactorial disease. Elise Weisert¹, Luke Hamilton², Antonio R. Jimenez¹, Michael G. Wilkerson¹ 1. Dermatology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States. 2. The University of Texas Medical Branch John Sealy School of Medicine, Galveston, TX, United States. Clinical Research: Epidemiology and Observational Research