The Journal of Dermatology

<jats:title>Abstract</jats:title><jats:p>The long‐term complications of coronavirus disease 2019 (COVID‐19) continue to cause global concern. This study aimed to estimate the incidence and risk of chronic urticaria, vitiligo, alopecia areata, and herpes zoster following COVID‐19 infection. Only participants confirmed by real‐time reverse transcription‐polymerase chain reaction tests to have COVID‐19 were enrolled in the COVID‐19 group. The matched cohort without COVID‐19 was enrolled randomly at a ratio of 1:1. The incidence and risk of chronic urticaria, vitiligo, alopecia areata, and herpes zoster were assessed in both groups using univariable and multivariable Cox proportional hazard analyses. A total of 4 976 589 COVID‐19 patients (9.58% of the total population of South Korea) and an equivalent number of matched non‐infected control subjects were analyzed. Chronic urticaria, vitiligo, alopecia areata, and herpes zoster manifested at higher rates within the COVID‐19 cohort, even after multivariable adjustment for potential confounders. COVID‐19 may increase the risk of developing chronic urticaria, vitiligo, alopecia areata, and herpes zoster.</jats:p>

publication_history

received

accepted

published

National Research Foundation of Korea

Data resource profile: the national health information database of the National Health Insurance Service in South Korea

Int J Epidemiol

Vitiligo following COVID‐19 vaccination and primary infection: a case report and systematic review

Cureus

The long-term complications of coronavirus disease 2019 (COVID-19) continue to cause global concern. This study aimed to estimate the incidence and risk of chronic urticaria, vitiligo, alopecia areata, and herpes zoster following COVID-19 infection. Only participants confirmed by real-time reverse transcription-polymerase chain reaction tests to have COVID-19 were enrolled in the COVID-19 group. The matched cohort without COVID-19 was enrolled randomly at a ratio of 1:1. The incidence and risk of chronic urticaria, vitiligo, alopecia areata, and herpes zoster were assessed in both groups using univariable and multivariable Cox proportional hazard analyses. A total of 4 976 589 COVID-19 patients (9.58% of the total population of South Korea) and an equivalent number of matched non-infected control subjects were analyzed. Chronic urticaria, vitiligo, alopecia areata, and herpes zoster manifested at higher rates within the COVID-19 cohort, even after multivariable adjustment for potential confounders. COVID-19 may increase the risk of developing chronic urticaria, vitiligo, alopecia areata, and herpes zoster.

Epidemiological insights into chronic urticaria, vitiligo, alopecia areata, and herpes zoster following COVID-19 infection: A nationwide population-based study.

Epidemiological insights into chronic urticaria, vitiligo, alopecia areata, and herpes zoster following <scp>COVID</scp>‐19 infection: A nationwide population‐based study

JAMA Dermatology

Long-term autoimmune inflammatory rheumatic outcomes of COVID-19: a binational cohort study.

Ann Intern Med

Autoimmune and autoinflammatory connective tissue disorders following COVID-19.

JAMA Netw Open

Long-term risk of autoimmune and autoinflammatory connective tissue disorders following COVID-19.

JAMA Dermatol

Symptom prevalence, duration, and risk of hospital admission in individuals infected with SARS-CoV-2 during periods of omicron and delta variant dominance: a prospective observational study from the ZOE COVID Study.

Lancet

Autoantibodies neutralizing type I IFNs are present in ~4% of uninfected individuals over 70 years old and account for ~20% of COVID-19 deaths.

Sci Immunol

Inborn errors of type I IFN immunity in patients with life-threatening COVID-19.

Science

Defective activation and regulation of type I interferon immunity is associated with increasing COVID-19 severity.

Nat Commun

Human genetic and immunological determinants of critical COVID-19 pneumonia.

Nature

Autoantibodies against type I IFNs in patients with life-threatening COVID-19.

Natural mucosal barriers and COVID-19 in children.

JCI Insight

The intersection of COVID-19 and autoimmunity.

J Clin Invest

New-onset IgG autoantibodies in hospitalized patients with COVID-19.

Diverse functional autoantibodies in patients with COVID-19.

Association of Epstein-Barr virus serological reactivation with transitioning to systemic lupus erythematosus in at-risk individuals.

Ann Rheum Dis

Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis.

COVID-19 as a Risk Factor For Autoimmune Skin Disease.

COVID-19 as a Risk Factor For Autoimmune Skin Disease

<jats:sec id="ab-doi240049-4"><jats:title>Importance</jats:title><jats:p>Few studies have investigated the association between COVID-19 and autoimmune and autoinflammatory connective tissue disorders; however, research with long-term observation remains insufficient.</jats:p></jats:sec><jats:sec id="ab-doi240049-5"><jats:title>Objective</jats:title><jats:p>To investigate the long-term risk of autoimmune and autoinflammatory diseases after COVID-19 over an extended observation period.</jats:p></jats:sec><jats:sec id="ab-doi240049-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>This retrospective nationwide population-based study investigated the Korea Disease Control and Prevention Agency–COVID-19–National Health Insurance Service (K-COV-N) cohort. Individuals with confirmed COVID-19 from October 8, 2020, to December 31, 2022, and controls identified among individuals who participated in the general health examination in 2018 were included in the analysis.</jats:p></jats:sec><jats:sec id="ab-doi240049-7"><jats:title>Exposures</jats:title><jats:p>Confirmed COVID-19.</jats:p></jats:sec><jats:sec id="ab-doi240049-8"><jats:title>Main Outcomes and Measures</jats:title><jats:p>Incidence and risk of autoimmune and autoinflammatory connective tissue disorders in patients after COVID-19. Various covariates, such as demographic characteristics, general health data, socioeconomic status, and comorbidity profiles, were balanced using inverse probability weighting.</jats:p></jats:sec><jats:sec id="ab-doi240049-9"><jats:title>Results</jats:title><jats:p>A total of 6 912 427 participants (53.6% male; mean [SD] age, 53.39 [20.13] years) consisting of 3 145 388 with COVID-19 and 3 767 039 controls with an observational period of more than 180 days were included. Alopecia areata (adjusted hazard ratio [AHR], 1.11 [95% CI, 1.07-1.15]), alopecia totalis (AHR, 1.24 [95% CI, 1.09-1.42]), vitiligo (AHR, 1.11 [95% CI, 1.04-1.19]), Behçet disease (AHR, 1.45 [95% CI, 1.20-1.74]), Crohn disease (AHR, 1.35 [95% CI, 1.14-1.60]), ulcerative colitis (AHR, 1.15 [95% CI, 1.04-1.28]), rheumatoid arthritis (AHR, 1.09 [95% CI, 1.06-1.12]), systemic lupus erythematosus (AHR, 1.14 [95% CI, 1.01-1.28]), Sjögren syndrome (AHR, 1.13 [95% CI, 1.03-1.25]), ankylosing spondylitis (AHR, 1.11 [95% CI, 1.02-1.20]), and bullous pemphigoid (AHR, 1.62 [95% CI, 1.07-2.45]) were associated with higher risk in the COVID-19 group. Subgroup analyses revealed that demographic factors, including male and female sex, age younger than 40 years, and age 40 years and older, exhibited diverse associations with the risk of autoimmune and autoinflammatory outcomes. In addition, severe COVID-19 infection requiring intensive care unit admission, the Delta period, and not being vaccinated were associated with higher risk.</jats:p></jats:sec><jats:sec id="ab-doi240049-10"><jats:title>Conclusions and Relevance</jats:title><jats:p>This retrospective cohort study with an extended follow-up period found associations between COVID-19 and the long-term risk of various autoimmune and autoinflammatory connective tissue disorders. Long-term monitoring and care of patients is crucial after COVID-19, considering demographic factors, disease severity, and vaccination status, to mitigate these risks.</jats:p></jats:sec>

Post-acute sequelae of COVID-19: understanding and addressing the burden of multisystem manifestations.

Lancet Respir Med

Global burden of COVID-19: situational analysis and review.

Hum Antibodies

COVID-19-related acute kidney injury: incidence, risk factors and outcomes in a large UK cohort.

BMC Nephrol

COVID-19 and cardiovascular comorbidities.

Exp Clin Endocrinol Diabetes

Tüberk Toraks

COVID-19 and autoimmune diseases.

Curr Opin Rheumatol

SARS-CoV-2, the autoimmune virus.

Autoimmun Rev

Risk of autoimmune diseases following COVID-19 and the potential protective effect from vaccination: a population-based cohort study.

EClinicalMedicine

Data resource profile: the National Health Information Database of the National Health Insurance Service in South Korea.

Cohort Profile: The National Health Insurance Service-National Sample Cohort (NHIS-NSC), South Korea.

All-cause and cause-specific mortality risks associated with alopecia areata: a Korean nationwide population-based study.

Autoimmune inflammatory rheumatic diseases post–COVID-19 vaccination.

Int Immunopharmacol

Long-term cardiovascular outcomes of COVID-19.

Nat Med

Status and characteristics of the SARS-CoV-2 variant outbreak in the Republic of Korea in January 2021.

Public Health Weekly Report

A review of heart failure in patients with COVID-19.

Heart Fail Clin

Front Epidemiol

The role of cytokines and chemokines in severe acute respiratory syndrome coronavirus 2 infections.

Front Immunol

Patients with COVID-19 exhibit different immunological profiles according to their clinical presentation.

Int J Infect Dis

Characteristics and prognostic factors of disease severity in patients with COVID-19: the Beijing experience.

J Autoimmun

Prognostic value of interleukin-18 and its association with other inflammatory markers and disease severity in COVID-19.

Cytokine

Autoimmunity, COVID-19 Omicron variant, and olfactory dysfunction: a literature review.

Diagnostics (Basel)

The Omicron (B.1.1.529) SARS-CoV-2 variant of concern does not readily infect Syrian hamsters.

Antiviral Res

Clinical and experimental evidence suggest Omicron variant of SARS-CoV-2 is inherently less pathogenic than delta variant independent of previous immunity.

Eur J Med Res

Risk of autoimmune diseases in patients with COVID-19: a retrospective cohort study.

Vaccine-induced autoimmunity: the role of molecular mimicry and immune crossreaction.

Cell Mol Immunol

Infection and Autoimmunity

A possible role for autoimmunity through molecular mimicry in alphavirus mediated arthritis.

Sci Rep

Untangling COVID-19 and autoimmunity: identification of plausible targets suggests multi organ involvement.

Mol Immunol

SARS-CoV-2–specific immune response and the pathogenesis of COVID-19.

Int J Mol Sci

Molecular mimicry, bystander activation, or viral persistence: infections and autoimmune disease.

Clin Microbiol Rev

Systems immunology analysis reveals the contribution of pulmonary and extrapulmonary tissues to the immunopathogenesis of severe COVID-19 patients.

The type I interferon response in COVID-19: implications for treatment.

Nat Rev Immunol

Systemic lupus erythematosus after coronavirus disease-2019 (COVID-19) infection: case-based review.

Egypt Rheumatol

New onset systemic lupus erythematosus after COVID-19 infection: a case report.

AME Case Rep

New diagnosis of systemic lupus erythematosus after COVID-19 vaccination: a case report and review of literature.

JAAD Case Rep

Axial spondylarthritis following COVID-19 infection.

BMJ Case Rep

Rheumatoid arthritis occurring after coronavirus disease 2019 (COVID-19) infection: case based review.

COVID-19 infection and rheumatoid arthritis: mutual outburst cytokines and remedies.

Curr Med Res Opin

Analysis of the potential relationship between COVID-19 and Behcet’s disease using transcriptome data.

Medicine (Baltimore)

Rheumatologists’ perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets.

Clin Rheumatol

New-onset vitiligo following COVID-19 disease.

Skin Health Dis

Vitiligo following COVID-19: a case report and review of pathophysiology.

Vitiligo pathogenesis and emerging treatments.

Dermatol Clin

Virol Immunol J

COVID-19 and oxidative stress.

Biochemistry (Mosc)

New-onset bullous pemphigoid in a COVID-19 patient.

Case Rep Dermatol Med

Bullous pemphigoid outcome is associated with CXCL10-induced matrix metalloproteinase 9 secretion from monocytes and neutrophils but not lymphocytes.

J Allergy Clin Immunol

Three case reports of post immunization and post viral Bullous Pemphigoid: looking for the right trigger.

BMC Pediatr

Few studies have investigated the association between COVID-19 and autoimmune and autoinflammatory connective tissue disorders; however, research with long-term observation remains insufficient.
To investigate the long-term risk of autoimmune and autoinflammatory diseases after COVID-19 over an extended observation period.
This retrospective nationwide population-based study investigated the Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service (K-COV-N) cohort. Individuals with confirmed COVID-19 from October 8, 2020, to December 31, 2022, and controls identified among individuals who participated in the general health examination in 2018 were included in the analysis.
Confirmed COVID-19.
Incidence and risk of autoimmune and autoinflammatory connective tissue disorders in patients after COVID-19. Various covariates, such as demographic characteristics, general health data, socioeconomic status, and comorbidity profiles, were balanced using inverse probability weighting.
A total of 6 912 427 participants (53.6% male; mean [SD] age, 53.39 [20.13] years) consisting of 3 145 388 with COVID-19 and 3 767 039 controls with an observational period of more than 180 days were included. Alopecia areata (adjusted hazard ratio [AHR], 1.11 [95% CI, 1.07-1.15]), alopecia totalis (AHR, 1.24 [95% CI, 1.09-1.42]), vitiligo (AHR, 1.11 [95% CI, 1.04-1.19]), Behçet disease (AHR, 1.45 [95% CI, 1.20-1.74]), Crohn disease (AHR, 1.35 [95% CI, 1.14-1.60]), ulcerative colitis (AHR, 1.15 [95% CI, 1.04-1.28]), rheumatoid arthritis (AHR, 1.09 [95% CI, 1.06-1.12]), systemic lupus erythematosus (AHR, 1.14 [95% CI, 1.01-1.28]), Sjögren syndrome (AHR, 1.13 [95% CI, 1.03-1.25]), ankylosing spondylitis (AHR, 1.11 [95% CI, 1.02-1.20]), and bullous pemphigoid (AHR, 1.62 [95% CI, 1.07-2.45]) were associated with higher risk in the COVID-19 group. Subgroup analyses revealed that demographic factors, including male and female sex, age younger than 40 years, and age 40 years and older, exhibited diverse associations with the risk of autoimmune and autoinflammatory outcomes. In addition, severe COVID-19 infection requiring intensive care unit admission, the Delta period, and not being vaccinated were associated with higher risk.
This retrospective cohort study with an extended follow-up period found associations between COVID-19 and the long-term risk of various autoimmune and autoinflammatory connective tissue disorders. Long-term monitoring and care of patients is crucial after COVID-19, considering demographic factors, disease severity, and vaccination status, to mitigate these risks.

Long-Term Risk of Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19.

Long-Term Risk of Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19

<jats:p>This cohort study examines the incidence, prevalence, and risk of alopecia areata after COVID-19.</jats:p>

Association between alopecia areata and COVID-19: a systematic review.

JAAD Int

Possible associations between alopecia areata and COVID-19 vaccination and infection.

Aesthet Surg J

Short-term stress-related increasing cases of alopecia areata during the COVID-19 pandemic.

J Dermatolog Treat

Lack of evidence of COVID-19 being a risk factor of alopecia areata: results of a national cohort study in South Korea.

Front Med (Lausanne)

Incidence and prevalence of alopecia areata according to subtype: a nationwide, population-based study in South Korea (2006-2015).

Br J Dermatol

This cohort study examines the incidence, prevalence, and risk of alopecia areata after COVID-19.

Risk of Alopecia Areata After COVID-19.

Risk of Alopecia Areata After COVID-19

Papers