PMC9198839_01
Photographs of the patient's scalp before treatment (A), 6 months after the start of treatment (B), and 1 year after the start of treatment (C).
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F1
On physical examination, the patient exhibited hair loss on her head and one entire side of her body (Figure 1A) but no hepatosplenomegaly. About 6 months after the start of ruxolitinib treatment, signs of improvement in other symptoms were observed, as was hair growth (Figure 1B); after 1 year, the improvement was dramatic (Figure 1C).
Skin biopsy of the scalp findings before (A-C) and 1 year after ruxolitinib treatment began (D-F). Hematoxylin and eosin stains (A,D; x200) and immunohistochemical stains for CD4 (B,E; x200) and CD8 (C,F; x200) showed that infiltrative CD8-positive T cells disappeared after treatment.
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F2
Skin biopsy revealed peribulbar lymphocytic inflammation (the "swarm of bees" sign; Figure 2A). Immunostaining showed both CD4- and CD8-positive lymphocytes (Figures 2B,C). Skin biopsy of the scalp at that time confirmed hair in multiple hair follicles, and the numbers of infiltrating lymphocytes around the hair roots were reduced (Figure 2D). CD4-positive lymphocytes were few and scattered, but almost no CD8-positive lymphocytes were observed (Figures 2E,F).