Azathioprine: A Therapy to Be Considered in Alopecia Universalis

The document reports a case of alopecia universalis (AU), a severe form of alopecia areata (AA), responding to azathioprine treatment. A 36-year-old woman with severe atopic eczema and AU experienced rapid hair regrowth within 6 weeks of starting azathioprine, with almost complete regrowth in 8 months. This response was observed on two separate occasions, suggesting the effectiveness of azathioprine for AU. Prior treatments with cyclosporine and methotrexate had either side effects or were ineffective for the alopecia. The document highlights that while there are various treatments for AA, including corticosteroids and topical immunotherapy, there are only two reports in the literature of azathioprine being used for AA, and this is the first reported case of AU responding to azathioprine. The rapid regrowth upon commencement of azathioprine treatment makes it unlikely that the response is purely coincidental.