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Severe and unresponsive HIV-associated alopecia areata successfully treated with thalidomide.

Sir, Alopecia areata (AA) is a non-scarring recurrent cause of hair loss afflicting approximately 1–2% of the general population. Up to 15% of patients progress to a severe form of the disease, and develop total scalp (alopecia totalis) or scalp and body hair loss (alopecia universalis). At this time spontaneous remission occurs rarely and the treatment is usually difficult. Thalidomide has turned out to be an extremely interesting drug, not only for inflammatory skin conditions. We describe here a patient with severe AA, resistant to several treatments, who showed a dramatic response to thalidomide.