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    Alopecia Areata and Psoriasis Vulgaris Associated With TS

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    ILham Syah
    This letter reports a case of a 58-year-old woman with Turner syndrome who presented with alopecia totalis and psoriasis vulgaris. She had a long history of treatment-resistant alopecia and also had Hashimoto's thyroiditis. During treatment with squaric acid dibutylester for her alopecia, psoriatic lesions developed on her scalp. This was accompanied by new hair growth within the psoriatic plaques, consistent with the Renbok phenomenon. Treatment with excimer laser therapy led to further hair regrowth over 5 months. The co-occurrence of alopecia, psoriasis and autoimmune diseases in this patient with Turner

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    Alopecia Areata and Psoriasis Vulgaris Associated With TS

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    ILham Syah
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    This letter reports a case of a 58-year-old woman with Turner syndrome who presented with alopecia totalis and psoriasis vulgaris. She had a long history of treatment-resistant alopecia and also had Hashimoto's thyroiditis. During treatment with squaric acid dibutylester for her alopecia, psoriatic lesions developed on her scalp. This was accompanied by new hair growth within the psoriatic plaques, consistent with the Renbok phenomenon. Treatment with excimer laser therapy led to further hair regrowth over 5 months. The co-occurrence of alopecia, psoriasis and autoimmune diseases in this patient with Turner

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    This letter reports a case of a 58-year-old woman with Turner syndrome who presented with alopecia totalis and psoriasis vulgaris. She had a long history of treatment-resistant alopecia and also had Hashimoto's thyroiditis. During treatment with squaric acid dibutylester for her alopecia, psoriatic lesions developed on her scalp. This was accompanied by new hair growth within the psoriatic plaques, consistent with the Renbok phenomenon. Treatment with excimer laser therapy led to further hair regrowth over 5 months. The co-occurrence of alopecia, psoriasis and autoimmune diseases in this patient with Turner

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    7 views3 pages

    Alopecia Areata and Psoriasis Vulgaris Associated With TS

    Uploaded by

    ILham Syah
    This letter reports a case of a 58-year-old woman with Turner syndrome who presented with alopecia totalis and psoriasis vulgaris. She had a long history of treatment-resistant alopecia and also had Hashimoto's thyroiditis. During treatment with squaric acid dibutylester for her alopecia, psoriatic lesions developed on her scalp. This was accompanied by new hair growth within the psoriatic plaques, consistent with the Renbok phenomenon. Treatment with excimer laser therapy led to further hair regrowth over 5 months. The co-occurrence of alopecia, psoriasis and autoimmune diseases in this patient with Turner

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    © All Rights Reserved
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    of 3

    Australasian Journal of Dermatology (2021) , – doi: 10.1111/ajd.

    13597

    LETTER TO THE EDITOR

    disease including alopecia areata (AA).1,2 Moreover, psori-


    Research Letter
    asis associated with Turner syndrome has also been
    reported.1 However, coexistence of AA and psoriasis is
    Dear Editor,
    rarely reported. We report a case of psoriasis vulgaris and
    AA associated with Turner syndrome.
    Alopecia areata and psoriasis vulgaris associated with
    A 58-year-old woman with Turner syndrome presented
    Turner syndrome
    with a more than ten-year history of alopecia totalis,
    refractory to treatment including squaric acid dibutylester.
    Turner syndrome is a chromosomal abnormality caused by
    Additionally, she had a background of Hashimoto’s thy-
    the absence or abnormality of the X chromosome.1 Turner
    roiditis on levothyroxine. On examination of the scalp, only
    syndrome is often associated with autoimmune skin

    Figure 1 Clinical and histological features of alopecia areata and psoriasis before the occurrence of psoriasis lesions on her scalp. (a,b)
    Total hair loss with telangiectasia on the scalp. (c) Lymphocytic inflammation is observed around the hair follicle (hematoxylin–eosin,
    original magnification 9200). (d,e) Psoriasis lesions on her legs. (f) Histopathological findings from her psoriasis lesions showing confluent
    parakeratosis, absent granular layers, acanthosis with club-shaped rete ridges of even length (hematoxylin–eosin, original magnification
    9100).

    © 2021 Australasian College of Dermatologists


    2 Letter to the Editor

    a single hair was detected (Fig. 1a,b). Scalp punch biopsy contributed to hair regrowth. The therapeutic efficacy of
    showed lymphocytic inflammation around the hair follicle squaric acid dibutylester in AA is hypothesised to involve
    (Fig. 1c). General skin examination revealed scaly erythe- myeloid-derived suppressor cells (MDSCs) which increase
    matous plaques on her extremities (Fig. 1d,e). Biopsy from TNF-a expression and suppress autoreactive T-cell prolif-
    the right knee revealed confluent parakeratosis, absent eration.4,5 In our case squaric acid, dibutylester treatment
    granular layers and acanthosis with club-shaped rete may have exacerbated psoriasis and contributed to the
    ridges of even length (Fig. 1f). Based on these findings, the refractory nature of psoriatic plaques on the scalp.
    patient was diagnosed with psoriasis vulgaris and AA. Our In summary, we report a woman with Turner syndrome
    patient presented with three-year history of treatment by who developed the concurrent autoimmune conditions AA,
    squaric acid dibutylester and scalp psoriasis appeared dur- psoriasis and Hashimoto’s thyroiditis. In this case, develop-
    ing the treatment. We started excimer laser therapy (308- ment of scalp psoriasis resulted in improvement of AA,
    nm) and discontinued squaric acid dibutylester. At consistent with Renbo € k phenomenon.
    5 months after the induction of excimer light therapy,
    growth of vellus and terminal hairs was noted (Fig. 2).
    Genetic disorders characterised by chromosomal abnor- ACKNOWLEDGEMENTS
    malities, such as Turner syndrome, are often associated
    We thank Dr. Taisuke Ito for the helpful discussions. The
    with autoimmune diseases.1 The high risk of autoimmune
    patient in this manuscript has given written informed con-
    diseases in women with Turner syndrome is hypothesised
    sent to the publication of her case details.
    to be due to multiple factors including haploinsufficiency
    of genes on the single X chromosome, constitutional up-
    regulation of IL-6 and TNF-a and oestrogen deficiency.3 FUNDING
    The Renbo € k phenomenon describes the disappearance
    No Funding.
    of a skin condition when another appears; for example,
    active psoriatic lesions on the scalp may induce hair
    regrowth in AA.3 Our patient initially presented with alope- CONFLICT OF INTEREST
    cia totalis; however, following the development of scalp
    The authors declare no conflict of interest.
    psoriasis, new hair growth appeared within psoriatic pla-
    ques, a pattern consistent with Renbo € k phenomenon. A
    Rei Yokoyama1 | Ryota Hayashi1 | Osamu
    charge is cytokine balance may be responsible for the
    Ansai1 | Akito Hasegawa1 | Satoru Shinkuma1 |
    Renbo € k phenomenon; AA is driven by a Th1 response
    Yutaka Shimomura2 | Riichiro Abe1
    whereas psoriasis is driven by Th1, Th17 and Th22. Fur-
    thermore, excimer light treatment in our case may have

    Figure 2 Clinical findings after the development of psoriasis lesions on her scalp. (a-c) Vellus and terminal hair remarkably grew on
    psoriasis lesions.

    © 2021 Australasian College of Dermatologists


    Letter to the Editor 3

    1
    Division of Dermatology, Niigata University Graduate with Turner Syndrome. Arch. Argent. Pediatr. 2014; 112: e209–
    School of Medical and Dental Sciences, Niigata and e212.
    2
    Department of Dermatology, Yamaguchi University 3. Jørgensen KT, Rostgaard K, Bache I et al. Autoimmune diseases
    in women with Turner’s syndrome. Arthritis Rheum. 2010; 62:
    Graduate School of Medicine, Ube, Yamaguchi, Japan
    658–66.
    4. Singh V, Mueller U, Freyschmidt-Paul P et al. Delayed type
    hypersensitivity-induced myeloid-derived suppressor cells regu-
    REFERENCES
    late autoreactive T cells. Eur. J. Immunol. 2011; 41: 2871–82.
    1. Lowenstein EJ, Kim KH, Glick SA. Turner’s syndrome in der- 5. Ito T, Hashizume H, Takigawa M. Contact immunotherapy-in-
    matology. J. Am. Acad. Dermatol. 2004; 50: 767–76. duced Renbo € k phenomenon in a patient with alopecia areata
    2. Dogruk Kacar S, Ozuguz P, Polat S. Coexistence of psoriasis, and psoriasis vulgaris. Eur. J. Dermatol. 2010; 20: 126–7.
    and alopecia areata with trachyonychia in a pediatric patient

    © 2021 Australasian College of Dermatologists

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