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).