Age: 44.0
Sex: M
Vaccine: COVID19
Symptoms: Full blood count, Hair colour changes, Physical examination, Prostatic specific antigen, SARS-CoV-2 test
Clinical narrative: Alopecia areata and subsequent Marie Antoinette syndrome following SARS-CoV2 infection and mRNA-1273 vaccinations; Alopecia areata and subsequent Marie Antoinette syndrome following SARS-CoV2 infection and mRNA-1273 vaccinations; This literature-non-study case was reported in a literature article and describes the occurrence of ALOPECIA AREATA (Alopecia areata and subsequent Marie Antoinette syndrome following SARS-CoV2 infection and mRNA-1273 vaccinations) and HAIR COLOUR CHANGES (Alopecia areata and subsequent Marie Antoinette syndrome following SARS-CoV2 infection and mRNA-1273 vaccinations) in a 44-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 prophylaxis.   The patient's past medical history included SARS-CoV-2 infection (claimed to be asymptomatic) in February 2021 and Cigarette smoker (He previously smoked a pack a week for 23 years but has been cigarette-free for 8 months).   On 05-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Jun-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. In May 2021, the patient experienced ALOPECIA AREATA (Alopecia areata and subsequent Marie Antoinette syndrome following SARS-CoV2 infection and mRNA-1273 vaccinations) (seriousness criterion medically significant). In June 2021, the patient experienced HAIR COLOUR CHANGES (Alopecia areata and subsequent Marie Antoinette syndrome following SARS-CoV2 infection and mRNA-1273 vaccinations) (seriousness criterion medically significant). The patient was treated with PREDNISONE (oral) on 25-May-2021 at a dose of 50 milligram once a day and BETAMETHASONE VALERATE on 25-May-2021 at a dose of 0.05 % percent, lotion. At the time of the report, ALOPECIA AREATA (Alopecia areata and subsequent Marie Antoinette syndrome following SARS-CoV2 infection and mRNA-1273 vaccinations) and HAIR COLOUR CHANGES (Alopecia areata and subsequent Marie Antoinette syndrome following SARS-CoV2 infection and mRNA-1273 vaccinations) had not resolved.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In February 2021, SARS-CoV-2 test: (Positive) claimed to be asymptomatic. In 2021, Blood albumin: Normal. In 2021, Blood glucose: Normal. In 2021, Blood thyroid stimulating hormone: Normal. In 2021, Blood triglycerides (Unknown-1.70 millimole per litre): 1.80 millimole per litre mildly elevated. In 2021, Full blood count: normal. In 2021, Physical examination: revealed diffuse white hair over the scalp with no evidence of scalp erythema, perifollicular scale, or circumscribed areas of hair loss. In 2021, Prostatic specific antigen: normal. In 2021, Serum ferritin: Normal.     For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered ALOPECIA AREATA (Alopecia areata and subsequent Marie Antoinette syndrome following SARS-CoV2 infection and mRNA-1273 vaccinations) to be related. No further causality assessment was provided for HAIR COLOUR CHANGES (Alopecia areata and subsequent Marie Antoinette syndrome following SARS-CoV2 infection and mRNA-1273 vaccinations).    It was reported that on an unspecified date in August-2021, patient was referred to clinic for rapid diffuse hair loss with subsequent depigmented, snow-white regrowth. The patient was tested positive for covid-19 but he was asymptomatic. After the first dose 2 weeks later, he developed well-circumscribed patches of hair loss on his scalp without itch or pain. The patient discontinued treatment lotion use after one tube due to significant dermatitis and abscesses. Both treatments were ineffective. No concomitant medications were reported.  One week after the second dose, he experienced diffuse hair loss on his scalp, eyelashes, beard hair, and eyebrows. His scalp was also intensely pruritic. Another week later, he experienced facial hair regrowth, followed by scalp hair. He endorsed the initial regrowth of both gray and brown hairs, but they had turned completely white 3 days later. His hair has continued to regrow, albeit thinner, and has remained diffusely white. No further treatment was attempted. The patient experienced further new-onset hair loss on his arms and lower legs since. Before May 2021, he endorsed a full head of brown hair, with intermittent gray hair. There is no personal or family history of hair loss, including androgenetic alopecia. The patient was healthy.  It was reported that between the first and second vaccination, he had well-circumscribed patchy hair loss, in keeping with alopecia areata. In first visit the patient was after both the hair loss and regrowth, were not able to perform trichoscopy or bedside diagnostic tests, to further delineate the nature of his hair loss. However, the well-circumscribed patchy hair loss as shown followed by a diffuse loss with additional affected areas, was a strong indication of alopecia areata. Furthermore, the spontaneous total regrowth, albeit depigmented, suggests a non-cicatricial etiology.  Company comment: This is a literature non-study case concerning a 44-year-old, male patient former smoker with no history of alopecia who experienced the serious (due to medically significant) unexpected, events of Alopecia areata and Hair colour changes (Marie Antoinette syndrome). Alopecia areata occurred 15 days after first dose of mRNA-1273 vaccine. Hair colour changes (Marie Antoinette syndrome) occurred one week after the second dose. The patient had a COVID-19 positive  test (asymptomatic) 3 months before initial symptoms. He developed well-circumscribed patches of hair loss on scalp without itch or pain. He was prescribed prednisone and betamethasone valerate which were ineffective. One week later, experienced diffuse hair loss on  scalp, eyelashes, beard hair, and eyebrows.  Another week later, he experienced facial hair regrowth, followed by scalp hair (brown and gray) but they turned completely white 3 days later. Events were reported as not solved. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.   Most recent FOLLOW-UP information incorporated above includes: On 30-Mar-2023: Follow up received by safety on 31-MAR-2023 has Email received, contains new updates. Reporter information, citation details, medical history, lab data, product, event and causality were updated.; Sender's Comments: This is a literature non-study case concerning a 44-year-old, male patient former smoker with no history of alopecia who experienced the serious (due to medically significant) unexpected, events of Alopecia areata and Hair colour changes (Marie Antoinette syndrome). Alopecia areata occurred 15 days after first dose of mRNA-1273 vaccine. Hair colour changes (Marie Antoinette syndrome) occurred one week after the second dose. The patient had a COVID-19 positive  test (asymptomatic) 3 months before initial symptoms. He developed well-circumscribed patches of hair loss on scalp without itch or pain. He was prescribed prednisone and betamethasone valerate which were ineffective. One week later, experienced diffuse hair loss on  scalp, eyelashes, beard hair, and eyebrows.  Another week later, he experienced facial hair regrowth, followed by scalp hair (brown and gray) but they turned completely white 3 days later. Events were reported as not solved. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.