Successful alopecia universalis treatment with the combination of cyclosporine and oral corticosteroid: a case report

Abstract

Background: Alopecia universalis is an autoimmune condition on hair follicles with the characteristics of ovoid or round-shaped hair loss (focal) that develops into multiple hair losses and is the most severe form of alopecia. The pathogenesis of alopecia universalis is unclear. However, the most accepted hypothesis is based on the immunologic factor, especially T-cell mediated autoimmune process. Case: A 19-year-old male Indonesian complained of hair loss all over his body. Efflorescence of the whole body showed an alopecia patch. The Severity of Alopecia Tool (SALT) score showed 100%. Skin dermoscopy indicated yellow dots. The patient was given 8 mg of intraoral methylprednisolone every 8 hours and 100 mg of intraoral cyclosporine every 12 hours for four weeks and slowly tapering off. The patient experienced acneiform eruption and was topically treated with 2% sulfur lotion every 12 hours. After 51 days of observation, an improvement was found in terminal hair growth on the head, eyelashes, and eyebrows, visible growth of vellus hair on the body, and a SALT score of 40%. Conclusion: Alopecia universalis is rare and can cause significant damage and psychological pressure to the affected individuals. Treatment with corticosteroid and cyclosporine resulted in good therapy response.