A scoping review of alopecia areata and its relationship to COVID-19 vaccinations

In response to the COVID-19 pandemic several vaccines were produced, including novel mRNA and viral vector-based vaccines. Though COVID-19 had its own associated dermatological sequelae, the vaccines were associated with a new set of cutaneous side effects, including hypersensitivity reactions, vasculitis, and autoimmune-mediated reactions. Notably, alopecia areata (AA) was reported in several patients closely following a COVID-19 vaccine, especially in those with a personal or family history of AA. A PubMed and Google Scholar search was conducted in July 2024 which resulted in 26 case reports/case series, 1 prospective study, and 3 cross-sectional retrospective chart reviews. Based on our holistic literature review, there is no evidence to support an increased association between COVID-19 vaccination and AA. Despite recent literature highlighting the incidence of de novo and recurrent AA after COVID-19 vaccines, several large retrospective analyses have shown that the overall incidence of AA in vaccinated individuals does not differ from that of historical controls. The potential for de novo AA after COVID-19 vaccine is low and the benefit of being vaccinated far outweighed the risks, especially within the first few years of COVID-19 vaccine rollout. While the decision to get vaccinated is a personal choice, the threat of developing AA secondary to vaccination should not be a deterrent.