Alopecia Universalis Occurring after Alemtuzumab Treatment for Multiple Sclerosis. A Two-Year Follow-Up of Two Patients

Alopecia Universalis (AU) is the most severe form of Alopecia Areata and is caused by cytotoxic T-cells reacting with follicular autoantigens, producing complete loss of scalp and body hair. Alemtuzumab is a highly efficacious monoclonal antibody used in the treatment of Multiple Sclerosis (MS), but...

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Bibliographic Details
Published in:International journal of environmental research and public health 2021-07, Vol.18 (14), p.7338
Main Authors: Borriello, Giovanna, Ianniello, Antonio, Toosy, Ahmed T
Format: Article
Language:English
Subjects:
Alopecia
Antibodies
Antigens
Autoantigens
Autoimmune diseases
Autoimmunity
Baldness
Case Report
Case reports
Cytokines
Cytotoxicity
Disease
Hair
Hair loss
Literature reviews
Lymphocytes
Lymphocytes T
Monoclonal antibodies
Multiple sclerosis
Pathogenesis
Patients
Regrowth
Scalp
Thyroid
Thyroid gland
Vitamin D
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Summary:Alopecia Universalis (AU) is the most severe form of Alopecia Areata and is caused by cytotoxic T-cells reacting with follicular autoantigens, producing complete loss of scalp and body hair. Alemtuzumab is a highly efficacious monoclonal antibody used in the treatment of Multiple Sclerosis (MS), but it causes secondary autoimmunity in up to 40% of patients. Many factors are believed to contribute to this process, but pathogenic mechanisms are not well clear. To date, three cases of AU after treatment with Alemtuzumab have been reported. In this paper we report the cases of two patients who developed AU 12 months after the second cycle of Alemtuzumab, with a review of the literature. One year after the end of the second cycle, two female patients in their thirties experienced complete hair loss. The first case was temporally associated with a significant drop in vitamin D (VD) levels. The second case was accompanied by joint swelling. Both patients had thyroid alterations and showed no hair regrowth after a 2-year follow-up. AU must be considered among the secondary autoimmune manifestations of Alemtuzumab treatment. We emphasize the need for appropriate patient screening and thorough clinical surveillance for factors predisposing patients to secondary autoimmunity.
ISSN:1660-4601
1661-7827
1660-4601
DOI:10.3390/ijerph18147338