Alopecia Universalis Associated with Ulcerative Colitis and the Role of Azathioprine

In 2018, a case was reported of a middle-aged man with alopecia universalis (complete hair loss) and a 6-year history of intermittent diarrheal attacks. He was diagnosed with ulcerative colitis, an inflammatory bowel disease, through colonoscopy and biopsy. His hair regrowth was achieved by treating him with azathioprine and mesalamine. The study highlighted the need for clinicians to consider alopecia universalis, combined with a history of diarrhea, as a possible extraintestinal manifestation of inflammatory bowel diseases like ulcerative colitis. The document also noted that the association of diffuse hair loss with ulcerative colitis is under-reported and often attributed to treatment side effects. The regrowth of hair after azathioprine prescription was previously reported only in two cases with Crohn's disease, making this potentially the first documented case of alopecia universalis responding to azathioprine in a patient with ulcerative colitis.