Alopecia universalis following DRESS, where rarities merge

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe, delayed-type drug hypersensitivity reaction that is characterized by fever, rash, lymphadenopathy, haematologic abnormalities (atypical lymphocytes, eosinophilia) and multi-organ involvement. Several autoimmune conditions that occur following DRESS have been reported previously. Here we present a woman who developed alopecia universalis (AU), 2 months after resolution of DRESS. A 37-year-old woman admitted to emergency room reporting 2 weeks of a rash. She had a history of arthralgia and was prescribed salicylazosulfapyridine, paracetamol and dexketoprofen 1 month ago. On physical examination, confluent violescent erythematous patches F I G U R E 1 Facial edema and confluent livid patches at the initial presentation (A-C), alopecia areata in the third month of follow up (D-F) and recovery from alopecia after 6 months of the treatment (G-I)

Hair loss after drug reaction with eosinophilia and systemic symptoms (DRESS): A multicentric retrospective case series

“…Nineteen alopecia cases reported after DRESS across several case reports and retrospective studies are summarized in Table 2 2,3,7–15 . Except for one patient who complained of hair loss at the initial presentation, the duration from DRESS onset to alopecia varied from weeks to years.…”

“…1 Although there are several reports on alopecia after DRESS, they only mention hair loss without detailing specific diagnoses or focus on alopecia areata (AA), including alopecia universalis (AU) or alopecia totalis (AT), as part of the interest in the autoimmune sequelae of DRESS. 2,3 However, as a subset of DRESS patients experience generalized persistent exfoliation, incidental destruction of hair follicles due to severe inflammation can lead to permanent alopecia (PA), defined as absent or incomplete hair growth after an insult. 4 In addition, because DRESS is a stressful systemic event it may also trigger telogen effluvium (TE).…”