Successful Treatment of Alopecia Universalis with Rituximab Therapy

The document reports the first case of successful treatment of alopecia universalis (AU), a severe form of alopecia areata characterized by complete body hair loss, with rituximab therapy in a 55-year-old female patient who also had adult dermatomyositis (DM). The patient initially responded to corticosteroids and cyclophosphamide for DM but relapsed and developed AU, which was unresponsive to standard treatments. After receiving intravenous rituximab, both her DM and AU entered remission within three months, and this remission was sustained for six years. This case suggests that rituximab, an anti-CD20 B cell therapy, may be an effective treatment for AU and indicates that B cells, rather than just T cells, may play a significant role in the disease's pathogenesis. The case also raises the possibility that type I Interferon (IFN) action on hair follicles, which is linked to disease activity in DM, may trigger AU. No conflicts of interest were disclosed by the authors.