INTRODUCTION
Alopecia areata is a chronic condition characterized by non-cicatricial
hair loss. Alopecia totalis (AT) is a subtype involving total scalp hair
loss. The pathophysiology of alopecia areata is not completely
understood1 but is thought to result from a T-cell
mediated inflammatory attack of the hair follicle unit secondary to
collapse of the hair follicles’ immune privilege.2,3Genetic predisposition and environmental factors may also contribute to
this autoimmune process.3
Hair loss can result in significant impairment of quality of life in
young people, affecting well-being, social functioning and mental
health.4 Pediatric patients with alopecia areata have
higher rates of depressive and anxious symptoms and experience a higher
prevalence of bullying.5,6 Unfortunately, therapeutic
options that result in durable remission of alopecia are
limited.7
Therapeutic modalities used include topical, intralesional and systemic
corticosteroids, as well as topical and systemic immunotherapy. In some
cases, patients with alopecia areata have achieved short-term remission
while receiving immunosuppressive therapy for other comorbid conditions
and these have been reported in the literature.8Resolution of alopecia universalis, a subtype of alopecia areata with
total body hair loss, has been described in patients receiving
hematopoietic stem cell transplant (HSCT).9,10However, this carries significant risks. There have been no reported
cases of complete sustained resolution of AT following standard-dose
chemotherapy.
Here, we describe complete and sustained resolution of AT in a pediatric
patient who was treated with chemotherapy for B-cell acute lymphoblastic
leukemia (B-ALL).