PMC9709177_01
Clinical photographs of the patient at first appointment. Images were captured by the patient, which were reviewed. Photos of alopecia totalis of the scalp with a few scattered tufts of hair and erythematous dry skin. (a) Lateral view shows patches of hair in the parietal vertex. (b) Posterior view shows hair patches in the occipital vertex. (c) Picture of dorsal hands with severe and active dermatitis with xerosis, scaling and erythematous lichenification bilaterally.
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AA and a positive family history for alopecia presented to our dermatology clinic for evaluation of his hair loss. A full physical exam was deferred as the COVID-19 pandemic necessitated a virtual appointment, but photos demonstrated nonscarring alopecia totalis of the scalp with a few scattered tufts of hair and dry lichenified plaques on the bilateral dorsal wrists and neck (Figure 1).
Clinical photographs of the patient after 1 month of treatment with cyclosporine. New hair growth in the frontal scalp. Confluent patches of smooth noon scarring alopecia in irregular areas of the occiput, vertex, parietal and temporal scalp. (a) Frontal, (b) posterior, (c) superior and (d) lateral view.
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Treatment was well tolerated, with new hair growth in the frontal scalp and noticeable improvements in AD after just a month (Figure 2), as well as further improvements in the eyebrows after 5 months.
Clinical photographs of the patient after 5 months of treatment with upadacitinib. Significant hair growth in the entire scalp. (a) Frontal, (b) lateral, (c) posterior and (d) superior view of the scalp.
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Improvements in both AA and AD were noted only 6 weeks after initiating upadacitinib, and by 5 months, the whole scalp was covered in hair (Figure 3).