{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T22:49:35Z","timestamp":1780440575805,"version":"3.54.1"},"reference-count":31,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T00:00:00Z","timestamp":1676419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>COVID-19 vaccines have positively changed the course of the pandemic. They entered the market after only one year of the initial trials, which that yielded positive results in terms of safety and efficacy. However, after inoculating billions of people in the most extensive vaccination campaign worldwide, mild but common and some rare but potentially fatal adverse events have been reported. Among several self-reported adverse events, hair loss and alopecia have been linked to COVID-19 mRNA or viral vector vaccines. We tracked and followed a series of five cases with post-vaccine telogen effluvium and alopecia development in Ecuador. Here, we reported the clinical presentation of two women and three men with the diagnosis of post-vaccine hair loss. All patients received a heterologous vaccination scheme (mRNA and attenuated virus vaccine) with an additional viral vector booster associated with the apparition of telogen effluvium and alopecia universalis between 3 and 17 days after the vaccine was administered.<\/jats:p>","DOI":"10.3390\/vaccines11020444","type":"journal-article","created":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T03:09:21Z","timestamp":1676430561000},"page":"444","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["A Case Series and Literature Review of Telogen Effluvium and Alopecia Universalis after the Administration of a Heterologous COVID-19 Vaccine Scheme"],"prefix":"10.3390","volume":"11","author":[{"given":"Jenny","family":"Hern\u00e1ndez Arroyo","sequence":"first","affiliation":[{"name":"Centro M\u00e9dico Capilar, Quito 170517, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1178-0546","authenticated-orcid":false,"given":"Juan S.","family":"Izquierdo-Condoy","sequence":"additional","affiliation":[{"name":"One Health Research Group, Faculty of Medicine, Universidad de las Am\u00e9ricas, Quito 170137, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1895-7498","authenticated-orcid":false,"given":"Esteban","family":"Ortiz-Prado","sequence":"additional","affiliation":[{"name":"One Health Research Group, Faculty of Medicine, Universidad de las Am\u00e9ricas, Quito 170137, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5945","DOI":"10.1016\/j.vaccine.2007.04.070","article-title":"Do We Fully Understand the Economic Value of Vaccines?","volume":"25","author":"Drummond","year":"2007","journal-title":"Vaccine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"115094","DOI":"10.1016\/j.diagmicrobio.2020.115094","article-title":"Clinical, Molecular, and Epidemiological Characterization of the SARS-CoV-2 Virus and the Coronavirus Disease 2019 (COVID-19), a Comprehensive Literature Review","volume":"98","author":"Guaman","year":"2020","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e107","DOI":"10.1056\/NEJMp2031373","article-title":"Emergency Use Authorization of COVID Vaccines\u2014Safety and Efficacy Follow-up Considerations","volume":"383","author":"Krause","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"22440","DOI":"10.1038\/s41598-021-01831-0","article-title":"The Role of Good Governance in the Race for Global Vaccination during the COVID-19 Pandemic","volume":"11","author":"Tatar","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1937","DOI":"10.1001\/jama.2020.19692","article-title":"Postapproval Vaccine Safety Surveillance for COVID-19 Vaccines in the US","volume":"324","author":"Lee","year":"2020","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.puhe.2021.02.025","article-title":"Vaccine Hesitancy in the Era of COVID-19","volume":"194","author":"Troiano","year":"2021","journal-title":"Public Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s12291-021-00968-z","article-title":"Adverse Events Reported From COVID-19 Vaccine Trials: A Systematic Review","volume":"36","author":"Kaur","year":"2021","journal-title":"Indian J. Clin. Biochem."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Ortiz-Prado, E., Izquierdo-Condoy, J.S., Fernandez-Naranjo, R., Simba\u00f1a-Rivera, K., V\u00e1sconez-Gonz\u00e1lez, J., Naranjo, E.P.L., Cordovez, S., Coronel, B., Delgado-Moreira, K., and Jimbo-Sotomayor, R. (2022). A Comparative Analysis of a Self-Reported Adverse Events Analysis after Receiving One of the Available SARS-CoV-2 Vaccine Schemes in Ecuador. Vaccines, 10.","DOI":"10.20944\/preprints202205.0243.v1"},{"key":"ref_9","first-page":"1663","article-title":"COVID-19 Vaccines: Comparison of Biological, Pharmacological Characteristics and Adverse Effects of Pfizer\/BioNTech and Moderna Vaccines","volume":"25","author":"Meo","year":"2021","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1111\/ajt.16516","article-title":"Allergic Reactions Including Anaphylaxis after Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine\u2014United States, December 14-23, 2020","volume":"21","author":"Shimabukuro","year":"2021","journal-title":"Am. J. Transplant. Off. J. Am. Soc. Transplant. Am. Soc. Transpl. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3727","DOI":"10.1111\/jocd.14459","article-title":"Alopecia Areata after ChAdOx1 NCoV-19 Vaccine (Oxford\/AstraZeneca): A Potential Triggering Factor?","volume":"20","author":"Essam","year":"2021","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3753","DOI":"10.1111\/jocd.14581","article-title":"Recurrence of Alopecia Areata after COVID-19 Vaccination: A Report of Three Cases in Italy","volume":"20","author":"Rossi","year":"2021","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jaad.2017.04.1141","article-title":"Alopecia Areata: Disease Characteristics, Clinical Evaluation, and New Perspectives on Pathogenesis","volume":"78","author":"Strazzulla","year":"2018","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/j.jaad.2015.12.026","article-title":"Pulse Corticosteroid Therapy with Oral Dexamethasone for the Treatment of Adult Alopecia Totalis and Universalis","volume":"74","author":"Ma","year":"2016","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1001\/jamadermatol.2018.2312","article-title":"Hair Regrowth Outcomes of Contact Immunotherapy for Patients With Alopecia Areata: A Systematic Review and Meta-Analysis","volume":"154","author":"Lee","year":"2018","journal-title":"JAMA Dermatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.jaad.2018.07.013","article-title":"Comorbidities in Alopecia Areata: A Systematic Review and Meta-Analysis","volume":"80","author":"Lee","year":"2019","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_17","unstructured":"(2022, November 20). VAERS Vaccine Adverse Events Reporting System\u2014Data, Available online: https:\/\/vaers.hhs.gov\/data.html."},{"key":"ref_18","unstructured":"(2022, November 20). UK Government Coronavirus (COVID-19) Vaccines Adverse Reactions, Available online: https:\/\/www.gov.uk\/government\/publications\/coronaviruscovid-19-vaccine-adverse-reactions."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e6039","DOI":"10.1002\/ccr3.6039","article-title":"COVID-19 Vaccination and Alopecia Areata: A Case Report and Literature Review","volume":"10","author":"Ganjei","year":"2022","journal-title":"Clin. Case Rep."},{"key":"ref_20","first-page":"1","article-title":"Alopecia Areata after SARS-CoV-2 Vaccination","volume":"20","author":"Scollan","year":"2021","journal-title":"JAAD Case Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e15689","DOI":"10.1111\/dth.15689","article-title":"Intractable Alopecia Areata Following the Second Dose of COVID-19 Vaccination: Report of Two Cases","volume":"35","author":"Chen","year":"2022","journal-title":"Dermatol. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"129","DOI":"10.7774\/cevr.2022.11.1.129","article-title":"Alopecia Areata after COVID-19 Vaccination","volume":"11","author":"Gallo","year":"2022","journal-title":"Clin. Exp. Vaccine Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"199","DOI":"10.4103\/jewd.jewd_18_22","article-title":"Induction of Alopecia Areata after COVID-19 Vaccination: A Case Report in the United States","volume":"19","author":"Lin","year":"2022","journal-title":"J. Egypt. Women\u2019s Dermatol. Soc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1001\/jama.1997.03550140068042","article-title":"Hair Loss after Routine Immunizations","volume":"278","author":"Wise","year":"1997","journal-title":"JAMA"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1016\/j.jisp.2017.10.007","article-title":"Race and Alopecia Areata amongst US Women","volume":"19","author":"Thompson","year":"2018","journal-title":"J. Investig. Dermatol. Symp. Proc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1002\/art.22672","article-title":"A Multiethnic, Multicenter Cohort of Patients with Systemic Lupus Erythematosus (SLE) as a Model for the Study of Ethnic Disparities in SLE","volume":"57","author":"Andrade","year":"2007","journal-title":"Arthritis Rheum."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1111\/j.1365-2133.2010.09775.x","article-title":"Type 1 Interferon Signature in the Scalp Lesions of Alopecia Areata","volume":"163","author":"Ghoreishi","year":"2010","journal-title":"Br. J. Dermatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.1038\/jidsymp.2013.24","article-title":"Hepatitis C Treatment and Alopecia Totalis","volume":"16","author":"Goh","year":"2013","journal-title":"J. Investig. Dermatol. Symp. Proc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"101624","DOI":"10.1016\/j.eclinm.2022.101624","article-title":"Impact of COVID-19 Vaccination on the Risk of Developing Long-COVID and on Existing Long-COVID Symptoms: A Systematic Review","volume":"53","author":"Notarte","year":"2022","journal-title":"eClinicalMedicine"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Izquierdo-Condoy, J.S., Fernandez-Naranjo, R., Vasconez-Gonz\u00e1lez, E., Cordovez, S., Tello-De-la-Torre, A., Paz, C., Delgado-Moreira, K., Carrington, S., Viscor, G., and Ortiz-Prado, E. (2022). Long COVID at Different Altitudes: A Countrywide Epidemiological Analysis. Int. J. Environ. Res. Public. Health, 19.","DOI":"10.3390\/ijerph192214673"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.jiph.2023.01.012","article-title":"Comparative Analysis of Long-Term Self-Reported COVID-19 Symptoms among Pregnant Women","volume":"16","author":"Cordovez","year":"2023","journal-title":"J. Infect. Public Health"}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/11\/2\/444\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:35:46Z","timestamp":1760121346000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/11\/2\/444"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,15]]},"references-count":31,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["vaccines11020444"],"URL":"https:\/\/doi.org\/10.3390\/vaccines11020444","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,15]]}}}