TLDR Untreated epidermolysis bullosa acquisita can cause total hair and nail loss.
A 61-year-old woman with epidermolysis bullosa acquisita (EBA) experienced scarring alopecia and total nail loss after discontinuing treatment for financial reasons. Initially, she presented with erosions and scarring, and tests confirmed EBA. Despite treatment with prednisolone, her condition worsened after stopping medication, leading to severe scalp and nail involvement. This case is notable as it is the first reported instance of EBA causing both total alopecia and complete nail loss, highlighting the potential for severe outcomes if EBA is left untreated. The study suggests that effector T cells may target hair follicles and nail matrix, compromising immune privilege and resulting in these symptoms.
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