A case of alopecia universalis with hyperthyroidism treated with azathioprine and hydroxychloroquine

Alopecia areata (AA) is a common form of multifactorial immune-mediated non-scarring alopecia

Case report: A 35-year-old married woman presented to the clinic with gradual loss of all body hair over a month

Top and side views AU showing hair loss on the scalp, eyebrows and eyelashes:

On examination, she also had changes in proptosis, and her body surface was warm and heat-labile, but she had no goiter

The patient was diagnosed with AU with autoimmune hyperthyroidism and started oral prednisolone 40 mg daily and the topical steroid fluocinolone, 2% minoxidil, and carbimazole

Frontal and side views of AU scalp, eyebrow and eyelash growth at 1 month after azathioprine and hydroxychloroquine use:

The exact pathogenesis of AA remains unknown, but it is believed that autoimmunity, genetics, environmental factors and stress all play a role

Here, hyperthyroid AU resistant to oral steroid therapy was successfully treated with azathioprine and hydroxychloroquine and was able to maintain hair growth until patient follow-up

Reference: Paudel V, Chudal D, Pradhan MB, Thakur R, Pandey BR.