Multiple Sclerosis and Alopecia Areata: Drug-Induced Alopecia Areata or Coexisting Autoimmune Phenomena?
TLDR Some multiple sclerosis treatments may trigger hair loss conditions like alopecia areata.
Alopecia areata (AA) is an autoimmune condition that can co-occur with multiple sclerosis (MS) due to shared genetic loci. The paper discusses the potential for drug-induced alopecia areata (DIAA), particularly following treatment with alemtuzumab, a monoclonal antibody used in MS that has been associated with secondary autoimmunity in up to 40% of patients. The paper presents a case of a 35-year-old man with relapsing-remitting MS who developed alopecia universalis (AU) after two courses of alemtuzumab, with varying degrees of hair regrowth following each episode. This case, along with 12 others reported in the literature, suggests a variable timeframe for the onset of AA post-alemtuzumab infusion. The pathogenesis of AA is believed to involve increased major histocompatibility complex activity in hair follicle cells and elevated levels of cytokines such as IFN-γ and IL-6. The immune reconstitution phase post-alemtuzumab treatment, characterized by cytokine release, may trigger AA. The paper emphasizes the need for accurate phenotyping and a multidisciplinary approach to better understand and manage the relationship between DIAA, MS treatments, and the pathogenesis of AA.
