Alopecia areata universalis showing excellent response to combination treatment modalities

Alopecia areata (AA) is a non-scarring alopecia with mainly an autoimmune etiopathogenesis. The most severe AA variant is alopecia areata universalis (AAU), characterized by a total loss of scalp and body hair. AAU poses a significant psychosocial impact and may require combination therapy to provide satisfying results. A 15-year-old male presented with total loss of scalp and body hair in the last three years. Physical examination showed total alopecia with no terminal hairs nor scarring. Dermoscopic examination exhibited black dots, yellow dots, and empty follicles. The patient's laboratory examination also indicated reactive anti-CMV IgG, anti-toxoplasma IgG, and anti-rubella IgG. The patient was then given combination treatment consisting of pulse-dose oral antivirus, inosine pranobex, topical corticosteroid and minoxidil, intralesional steroid injection, and light-emitting diode (LED) therapy. A course of 8-month-therapy showed significant improvement marked by hair regrowth. Diagnosis of AAU was established clinically, with viral infection thought to be one of the main triggering factors. The use of combination therapy was considered safe and effective for AAU patients, although the treatment might be continued long term. AAU is a disease that significantly impacts a patient's quality of life. Its management requires comprehensive treatment and may need a combination of several treatment modalities.