Sehgal VN, Bhattacharya SN, Sharma S, Srivastava G, Aggarwal AK. Alopecia areata progressing to totalis/universalis in non-insulin dependent diabetes mellitus (type II): Failure of dexamethasone-cyclophosphamide pulse therapy. Indian J Dermatol Venereol Leprol 2008;74:171-3

Sir,

The development of alopecia areata progressing to totalis/universalis in well-established non-insulin-dependent diabetes mellitus is an exclusive phenomenon, an indirect circumstantial evidence favoring it as an autoimmune disease. Dexamethasone-cyclophosphamide pulse was initiated but failed to produce a response.

A 47-year-old man, apparently well until a year ago….. His fasting and postprandial blood sugar levels were markedly elevated pointing to a diagnosis of NIDDM, for which oral anti-diabetics, along with dietary advice and appropriate oral and topical antibiotics were started. The preceding treatment ensured complete healing of the boils within 2 weeks. Four months later, he experienced spontaneous loss of hair over the legs progressing to involve other sites. In a short period of time, hair loss was noticed over the trunk, scalp and the beard area. It was accompanied by mild to moderate itching. However, hair loss was not preceded by any perifollicular papular or pustular lesions. The loss of hair over the scalp was total and was a source of embarrassment, which brought him for consultation. Examination of the skin was marked by loss of hair over the whole of the skin surface of the trunk, upper and lower extremities with patches of hair loss over the beard area. Hair pull test was positive. The complete loss of hair over the scalp was without any evidence of scarring or any skin lesion [Figure - 1], which was characteristic of AA. Routine total and differential leukocyte count, complete hemogram and blood biochemical parameters were within normal limits. However, his random blood sugar was 197 mg (normal up to 140) and glycosylated hemoglobin (HbA1c) was 9.6 percent (normal 9%-10% fair glycemic control). The hematoxylin eosin stained biopsy section from the area of hair loss showed dense lymphocytic infiltrate in the dermis involving the receding remnant of hair follicles….

Dr Proctor comments: unfortunately, dexamethasone treatment did not help.