PMC6289959_01
Drug-induced alopecia areata-like reaction at 18 weeks on dupilumab. The reaction was noted throughout the entire scalp but was accentuated on the vertex and crown.
gr1.jpg
PMC6289959_01_gr1.jpg
fig1
Diffuse pink background erythema with ill-defined areas of nonscarring alopecia on the crown and temporal scalp were noted on examination (Fig 1) Punch biopsy results showed alopecia areata-like hair miniaturization with peribulbar chronic inflammation and severe sebaceous gland atrophy (Figs 2 and 3).
Most hairs are miniaturized, and many of the hairs are in the catagen/telogen phase. Some mild chronic inflammation is evident.
gr2.jpg
PMC6289959_01_gr2.jpg
fig2
Diffuse pink background erythema with ill-defined areas of nonscarring alopecia on the crown and temporal scalp were noted on examination (Fig 1) Punch biopsy results showed alopecia areata-like hair miniaturization with peribulbar chronic inflammation and severe sebaceous gland atrophy (Figs 2 and 3).
In this image, 2 anagen phase and 1 telogen phase hairs are seen, but sebaceous glands are severely atrophic and can barely be recognized as sebaceous structures. Mild, chronic perivascular inflammation can also be appreciated at this level.
gr3.jpg
PMC6289959_01_gr3.jpg
fig3
Diffuse pink background erythema with ill-defined areas of nonscarring alopecia on the crown and temporal scalp were noted on examination (Fig 1) Punch biopsy results showed alopecia areata-like hair miniaturization with peribulbar chronic inflammation and severe sebaceous gland atrophy (Figs 2 and 3).
Reversal of hair loss 8 weeks after discontinuing dupilumab and after 1 round of intralesional triamcinolone acetonide injections.
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PMC6289959_01_gr4.jpg
fig4
No remaining areas of alopecia, scale, or erythema were noted on examination 8 weeks later (Fig 4).