The potential efficacy of thalidomide in the treatment of recalcitrant alopecia areata

Failure of two TNF-alpha blockers to influence the course of alopecia areata

Alopecia areata is a form of hair loss believed to be due to an anti-hair-bulb autoimmune process in which CD4 and CD8 lymphocytes affect the peribulb area. Alopecia universalis is the most severe form of alopecia areata and manifests itself as a complete loss of all body hair. The authors present the case of a 44-year-old psoriasis patient with a 20-year history of alopecia universalis who failed to respond to etanercept in terms of skin psoriasis and alopecia universalis, while reporting improvement in arthropathy. While tumor necrosis factor-alpha inhibitors succeeded in the treatment of some autoimmune disorders, reports of alopecia areata failures and this one of alopecia universalis demonstrate resistance to such treatment. Tumor necrosis factor-alpha inhibitors seem to not represent an effective treatment modality for alopecia universalis. The understanding gained from this experience should redirect the aims of alopecia areata therapy toward alternate mechanistic interventions.