Post-COVID-19 Alopecia Universalis: Autoimmune Hair Loss and the Challenge of Relapse Management

Background: Alopecia universalis (AU) is the most severe form of alopecia areata (AA), characterized by complete scalp and body hair loss. While post-COVID-19 hair loss is often attributed to telogen effluvium (TE), emerging evidence suggests that COVID-19 may also trigger AU through immune dysregulation, particularly via interferon-gamma (IFN-γ)-mediated inflammation. The chronic and relapsing nature of AU raises challenges in long-term disease management, particularly regarding treatment duration and relapse prevention. Case Presentation: We present a 79-year-old woman with no personal or family history of hair loss who developed sudden-onset AU one month after recovering from COVID-19. Initial treatment with topical and intralesional corticosteroids failed, prompting systemic therapy initiation. Over 10 months of treatment, she achieved significant hair regrowth. However, 3 months after discontinuation, hair loss recurred, reinforcing the relapsing nature of post-COVID-19 AU. Conclusion: This case uniquely demonstrates the rapid onset and relapsing nature of post-COVID-19 AU, distinguishing it from idiopathic AU and emphasizing the need for modified long-term treatment strategies. While Janus kinase (JAK) inhibitors and other immunomodulatory therapies show promise, the risk of relapse upon treatment discontinuation highlights the need for further research into long-term management strategies and maintenance therapy tin post-viral AU.