Mofarrah Ramin, Mofarrah Ramina, Jahani Amiri Kousar, Ghasemi Maryam
Department of Dermatology, Faculty of Medicine, Islamic Azad University of Medical Sciences, Sari, Iran.
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
J Cosmet Dermatol. 2021 Mar;20(3):976-979. doi: 10.1111/jocd.13600. Epub 2020 Jul 24.
AA is an acquired dermatosis distributed universally, with multifactorial etiology. It affects the hair follicle with or without nail involvement, resulting in an acute nonscarring alopecia with a relapsing course. Being a relatively common skin disease, LPP (lichen planopilaris) is initiated by a chronic lymphocytic inflammation that selectively destructs the hair follicles and eventually leads to scarring alopecia. Also, even though there is enough literature available for the co-existence of AA and LPP with each other and their association with other autoimmune conditions, there are only very few reports on the anatomical concomitance of both disorders. AIMS: Although the incidence of not only one but two autoimmune diseases in an immunosuppressed individual is very unusual, we hereby report a case of co-localization of AA and LPP in a patient receiving immunosuppression due to a previous history of SLE (Systemic lupus erythematosus).
A 37-year-old woman, housewife, presented to our office with general alopecia on the scalp since about two years ago (Figure 1), particularly on the vertex which was accompanied by mild itching and trichodynia. She had a history of hypothyroidism and lupus erythematosus arthritis. She had been receiving long-term treatment with prednisolone, hydroxychloroquine, azathioprine, and levothyroxine but had not been treated for hair loss. Despite being on all of the above-mentioned immunosuppressants, the patient developed AA and LPP which are both immune-mediated diseases.
In addition to continuing her oral immunosuppressants, the patient was treated with Minoxidil 5% and Clobetasol solution as well as a higher dose of Azathioprine than she was receiving beforehand. Approximately, 3 months into the treatment, the follicular hyperkeratosis and scalp erythema resolved. Also, hair growth could be seen on AA spots.
Our case report is indicating the possibly mutual immunopathogenesis of these two T cell-mediated disorders. Furthermore, we want to bring attention to the probability of new autoimmune diseases occurring even during treatment with immunosuppressive medications.
斑秃是一种病因多因素的、广泛分布的获得性皮肤病。它可累及毛囊，伴或不伴有指甲受累，导致急性非瘢痕性脱发且病程呈复发型。扁平苔藓性毛发角化病（LPP）是一种相对常见的皮肤病，由慢性淋巴细胞炎症引发，该炎症选择性破坏毛囊，最终导致瘢痕性脱发。此外，尽管有足够的文献报道斑秃和扁平苔藓性毛发角化病可同时存在，且它们与其他自身免疫性疾病有关联，但关于这两种疾病在解剖学上并存的报道却非常少。目的：尽管免疫功能低下个体同时患有一种甚至两种自身免疫性疾病的情况非常罕见，但我们在此报告一例因既往有系统性红斑狼疮（SLE）病史而接受免疫抑制治疗的患者，其斑秃和扁平苔藓性毛发角化病共定位的病例。
一名37岁的家庭主妇，约两年前开始出现头皮广泛性脱发（图1），尤其在头顶，伴有轻度瘙痒和拔毛痛。她有甲状腺功能减退和红斑狼疮性关节炎病史。她一直在接受泼尼松龙、羟氯喹、硫唑嘌呤和左甲状腺素的长期治疗，但未接受过脱发治疗。尽管使用了上述所有免疫抑制剂，该患者仍患上了斑秃和扁平苔藓性毛发角化病这两种免疫介导的疾病。
除继续服用口服免疫抑制剂外，患者还接受了5%米诺地尔和氯倍他索溶液治疗，以及比之前更高剂量的硫唑嘌呤治疗。治疗约3个月后，毛囊角化过度和头皮红斑消退。此外，在斑秃部位可见头发生长。
我们的病例报告表明这两种T细胞介导的疾病可能存在共同的免疫发病机制。此外，我们想提醒注意，即使在使用免疫抑制药物治疗期间，也可能出现新的自身免疫性疾病。
