Relapse in Alopecia Totalis after Successful Treatment with Intralesional Corticosteroid and Oral Immunomodulator

Alopecia areata (AA) is a chronic, recurrent, and non-scarring condition resulting in hair loss, which may affect all hair-bearing areas. There are three clinical patterns: patch AA, alopecia totalis, and alopecia universalis. Patients may show spontaneous recovery or respond well to treatment, but the disease may follow a course of relapse.

We report a case of recurrent alopecia totalis following successful treatment six years prior to the current visit. A 19-year-old female of Asian descent was admitted to our clinic due to recurrent hair loss in the last three months. Six years prior, she was diagnosed with alopecia totalis. After four years in remission, she started to have patchy hair loss. Dermatological examination revealed six nummular well-defined alopecia patches all over her parietal, temporal, and occipital scalp. She was treated with triamcinolone injection and light-emitting diode (LED). Additionally, topical minoxidil and hydrocortisone butyrate scalp solution were applied daily. Oral Inosine pranobex was administered twice a week. One year after the first re-administration of the therapy, complete remission was achieved.

Relapse in AA is common. Patients should be informed during education and counseling. Long term follow-up is essential in managing patients with AA.