Alopecia areata universalis after phenobarbital-induced anti-convulsant hypersensitivity syndrome.
Alopecia is an adverse effect in those patients taking aromatic anti-convulsant drugs but is rarely reported after discontinuing such medications in the convalescent status of anti-convulsant hypersensitivity syndrome (AHS). A 3-year-old boy developed alopecia areata (AA) universalis in the convalescent status of phenobarbital-induced AHS, compatible to the evidences of increased lymphocyte proliferation and increased dead cells percentages while his peripheral blood mononuclear cells were incubated with phenobarbital. Skin histology revealed peri-follicular, peri-bublar and supra-bublar lymphocyte infiltration. By searching for the key words AHS, alopecia areata (AA, punctuate absence of terminal scalp hair), AA totalis (complete absence of terminal scalp hair), and AA universalis (total loss of terminal scalp and body hair) using PubMed, only 2 cases, to date, developed alopecia in the convalescent status of phenobarbital-induced AHS. Among these 3 cases, all had favorable prognosis despite having jaundiced hepatitis. Their hair grew back after 2-3 months steroid therapy. Alopecia does rarely develop in the convalescent status of phenobarbital-induced AHS after stopping phenobarbital and its mechanism is related to lymphocyte infiltration into the peri-bulbar, supra-bulbar and peri-follicular regions.
Huang
Yu-Lin
YL
Primary Immunodeficiency Care and Research Institute, Chang Gung University College of Medicine, Chang Gung Children's and Memorial Hospital Taoyuan, Taiwan.
Hsieh
Meng-Ying
MY
Hsiao
Pa-Fan
PF
Sheen
Jiunn-Ming
JM
Yu
Hong-Ren
HR
Kuo
Ho-Chang
HC
Chen
Sung-Ting
ST
Huang
Jing-Long
JL
Yang
Kuender D
KD
Lee
Wen-I
WI
D000506:Alopecia Areata / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology; D000927:Anticonvulsants / Q000009:adverse effects*; D002675:Child, Preschool; D004342:Drug Hypersensitivity / Q000150:complications* / Q000276:immunology / Q000473:pathology; D006801:Humans; D008297:Male; D010634:Phenobarbital / Q000009:adverse effects*; D003294:Seizures, Febrile / Q000188:drug therapy
D000927:Anticonvulsants; D010634:Phenobarbital