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DRESS syndrome caused by efalizumab: comment

We report a case of targetoid hair regrowth pattern in a female patient with alopecia areata. A 39-year-old woman presented with a 2-month history of two discrete areas of hair loss affecting the vertex and occipital areas of her scalp. Three weeks before her visit to us, she had been seen privately by a consultant dermatologist, who had prescribed topical flucinolone acetonide 0.025% gel (Synalar; Astellas Pharma, Staines, Middlesex, UK). Physical examination showed two areas of hair loss on her scalp consistent with the diagnosis of alopecia areata. It was noted that in the centre of each area were a few fine hairs. She was advised to continue with the topical Synalar gel and was reviewed 8 weeks later. At this review, the area on her vertex had completely regrown. However, the area on the occiput was showing a striking targetoid pattern with concentric zones of hair regrowth (Figs 1). The regrown hair was of the same colour as the surrounding hair. This case highlights that hair regrowth in alopecia areata may follow different patterns, with these pictures demonstrating a striking targetoid pattern. Targetoid hair regrowth has previously been reported in alopecia areata and various mechanisms for the development of this unusual pattern have been hypothesized. These include the possible centrifugal accumulation of corticosteroid cream and an underlying earthquake -type mechanism, with a telogen wave causing the initial alopecia and then a hypothesized anagen wave potentially causing targetoid regrowth. However, none of these theories have been proven or studied beyond small series of case reports. Our case emphasizes that there is yet more to understand about the pathogenesis of alopecia areata.