TLDR Propylthiouracil can cause hair loss, reduced sweating, and nail issues, but stopping the drug can reverse hair and nail problems.
A 41-year-old Japanese woman developed alopecia areata (AA), generalized hypohidrosis, and onychomadesis after taking propylthiouracil (PTU) for Graves' disease. The symptoms included almost total hair loss, severe dry skin, heatstroke due to reduced sweating, and nail issues. A lymphocyte transformation test confirmed hypersensitivity to PTU. Histological analysis showed lymphocytic infiltration and damage to hair bulbs, but no significant changes in sweat glands. After discontinuing PTU, hair and nail symptoms fully recovered, but hypohidrosis persisted. This case suggests PTU can induce AA along with hypohidrosis and onychomadesis, with different pathogenic mechanisms for each condition.
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