Alopecia areata in a renal transplant recipient on cyclosporin

In 1996, a 30-year-old female who had undergone a renal transplant and was on cyclosporin therapy developed severe alopecia areata, a condition usually associated with autoimmune mechanisms. Surprisingly, the hair loss occurred despite the use of cyclosporin, which typically inhibits CD4+ T cell activation and can cause excessive hair growth. Her hair loss began 9 months post-transplant and initially improved but worsened after stopping prednisolone, another immunosuppressant. The reintroduction of prednisolone and reduction of azathioprine resulted in hair regrowth within 3-4 weeks, with both pigmented and unpigmented hairs returning after two months. This case adds to the limited reports of alopecia areata in patients on cyclosporin and suggests that CD4+ T cell activation might not be necessary for the development of this hair loss disorder.