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Successful Treatment of Alopecia Areata of the Eyelashes with FK 506 Ointment: A Case Report

Spelsberg H., Althaus C., Sundmacher R.,
Heinrich-Heine-Universität Düsseldorf, Universitäts-Augenklinik (Düsseldorf)

Purpose: Following androgenetic alopecia, alopecia areata is the most frequent type of hair loss which is charcterized by. many circular hairless areas on the hairy head. Severe generalized as well as isolated types of alopecia areata like manifestation on the eyelids with loss of eyelashes are known. Due to often temporarily existing a-symptomatic lesions the data on incidence are variable. Clinically, neither inflammation nor atrophy is observed. Aetiology remains unclear. Since pathogenesis is only partly known, a number of therapeutical approaches are currently suggested.
Method: A 34-years-old otherwise healthy woman reported sudden a-symptomatic loss of eyelashes of the left upper eyelid 7 years ago without any restitution. She had already undergone topical treatment with hydrocortisone 2.5% once daily without success. Clinically, blepharitis with sebaceous plugs was observed more in the left than in the right eye, which improved on mechanical lid margin care. The left upper eyelid showed complete madarosis. The dermatologists confirmed the diagnosis alopecia areata of the eyelashes and recommended a higher dosage of topical steroids without success. Since March 2001 the patient was treated with topical FK 506 0.1% (Protopicâ ointment) twice daily. After 6 months thin light eyelashes and after 10 months of continued treatment well-structured dark eyelashes were observed. The patient is very content with the cosmetic result.
Conclusions: An important differential diagnosis of isolated loss of eyelashes is trichotillomania. However, this was excluded regarding the well-groomed appearance of the patient. Most probably alopecia areata can be classified as an autoimmune disease. Therefore, both the immunosuppressive and the hair growth-stimulating (side-) effects of topical FK 506 0,1% justify the probatory and, at last, successful use of this substance. However, spontaneous remission, which is often observed in isolated types of alopecia areata, cannot be excluded completely.