PMC6098421_01
Clinical course of a 23-year-old woman with refractory alopecia areata.. Note: Because of refractory alopecia areata, the patient was administered five courses of intralesional corticosteroid therapy and three courses of systemic corticosteroid pulse therapy.. Abbreviations: NB UVB, narrowband ultraviolet B; ONFH, osteonecrosis of the femoral head; SADBE, squaric acid dibutylester; THA, total hip arthroplasty.
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Therefore, systemic corticosteroid pulse therapy was administered (Figure 1).
Therapeutic effect of a 23-year-old woman with refractory alopecia areata.. Notes: Localized patch progressed to extensive alopecia areata despite the first systemic corticosteroid pulse therapy. Therapeutic effect after the topical, systemic, and oral corticosteroid therapy is shown. (A) Hair loss and alopecic eyebrow. (B) Extensive loss of hair on the crown of the head.
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However, the clinical recurrence of extensive AA, nearly alopecia universalis (Figure 2A and B), was observed 3 months after the first course.
Radiographic images of the hips on high-dose corticosteroid therapy for refractory alopecia areata.. Notes: After the onset of right groin pain, (A) coronal view T1-weighted MRI shows characteristic low-signal band patterns (yellow arrows) on the bilateral femoral heads, which are suggestive of avascular necrosis. One year after diagnosis of bilateral osteonecrosis in the hip, (B) anterior-posterior radiograph shows massive broken and flattened (yellow arrows) subchondral bone of the right femoral head and progressive femoral head collapse. In the left femoral head, band-like sclerotic change (arrow heads) is observed.
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Based on these findings, she was diagnosed with stage three postcollapse ONFH on the right and stage one precollapse ONFH on the left (Figure 3).
Anterior-posterior radiograph of bilateral hips demonstrating cementless right total hip arthroplasty and left joint preservation following the surgery of core decompression and autologous bone graft.
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ONFH, she wanted a joint-preserving surgery, wherein core decompression and autologous bone graft were performed (Figure 4). One year postoperatively, three clinical scores in her hip improved (University of California, Los Angeles [UCLA] activity score, 4; Oxford hip score, 19 points; and Harris hip score [HHS], right: 90.0 points, left: 85.5 points) compared with those preoperatively (UCLA activity score, 2; Oxford hip score, 41 points; HHS, right: 36.0 points, left: 46.0 points).