Alopecia in Association with Severe Seborrhoeic Dermatitis Following Combination Antiretroviral Therapy for Acute Retroviral Syndrome

In 2005, a 27-year-old HIV-positive man developed severe seborrhoeic dermatitis (SD) and alopecia after starting combination antiretroviral therapy with stavudine, lamivudine, and efavirenz. The patient, with no previous skin disease history, experienced an increase in CD4 T-lymphocyte count and a decrease in HIV viral load following treatment. The SD and hair loss were successfully treated with a topical steroid and medicated shampoo, showing hair density improvement within a month. The authors of the case report speculated that the SD and alopecia might be due to an acute immune restitution syndrome, possibly triggered by an immune response to the yeast Malasseia ovale, and suggested that this could be a new manifestation of HAART-induced immune recovery in acute retroviral syndrome, meriting further study.