DISCUSSION
Here we report a case of complete resolution of AT following chemotherapy. The response of this patient’s AT to chemotherapeutic agents supports the theory that autoimmune dysfunction is a driver of the pathogenesis of alopecia areata. The resolution and sustained remission in this case suggests that the intensive immunosuppression from chemotherapy may have played a role in resetting her immune system. While it is also possible that this patient’s hair regrew as part of the natural history of alopecia areata, most patients with AT remain stable or worsen with time.11 This patient has no evidence of relapse of AT 6 years following chemotherapy completion. The prolonged remission along with the timing of hair regrowth during chemotherapy treatment suggests the possibility of a durable cure of AT with chemotherapy.
Prior to this case, there were two reported cases of sustained resolution of alopecia universalis following hematopoietic stem cell transplant (HSCT) for systemic malignancy. Seifert et al9 described complete resolution of alopecia universalis in a 40 year-old male patient following allogenic HSCT for chronic myeloid leukemia. Subsequently, Feher et al10reported a similar case in a 48 year-old male patient with alopecia universalis who was treated with chemotherapy and autologous HSCT for follicular lymphoma. In both of these cases, the authors hypothesized that myeloablative conditioning and autologous HSCT with immune reconstitution resulted in remission of the autoimmunity and resolution of this patient’s alopecia. In contrast, complete myeloablation and immune reconstitution was not part of this patient’s leukemia treatment, although we postulate that the standard dose chemotherapy-induced immune suppression she received played a role in the resolution of her AT.
Chemotherapy given in the context of systemic malignancy has previously been reported to coincide with resolution of other autoimmune dermatologic diseases such as psoriasis12 and hidradenitis suppurativa.13 Systemic autoimmune conditions, such as systemic lupus erythematous14 and rheumatoid arthritis15, have also been in remission following chemotherapy for cancer treatment. While the risks inherent with chemotherapy usually outweighs the morbidity of AT, the sustained remission of the AT following chemotherapy helps shed some light into the pathogenesis of and potential future therapeutic targets for this cosmetically debilitating and enigmatic disease. It would be worth reviewing the clinical course of other oncology patients who have concomitant alopecia areata and their long-term response to chemotherapy.
We highlight a case of sustained resolution of AT following chemotherapy for B-ALL in a pediatric patient. This case highlights the role of autoimmunity in the pathogenesis of AT and demonstrates that a reset of the host immune system using chemotherapy may provide a durable cure for AT.