Diffuse Alopecia Areata Associated with a Solid-Organ Malignancy: Case Report and Literature Review
Keywords:Alopecia areata, kidney cancer, autoimmune disease, paraneoplastic alopecia, hair loss disease.
Alopecia areata (AA) is an autoimmune disease, manifesting as non-scarring hair loss. Here we report a 57-year-old woman, who presented with sudden diffuse non-scarring hair loss on the scalp. Histology confirmed the diagnosis of AA. Imaging studies revealed the presence of an irregular mass in the left kidney, and histology demonstrated spindle cell-type renal cell carcinoma. There was spontaneous regrowth of hair after surgical and chemotherapy treatments. Reports of AA as first manifestation of malignancy are uncommon, and to our knowledge, this is the first report of AA as a paraneoplastic manifestation of renal cell carcinoma. This report also suggests that screening for malignancy should be considered in older patients, who present with sudden and diffuse AA.
Gilhar A, Kalish RS. Alopecia areata: a tissue specific autoimmune disease of the hair follicle. Autoimmun Rev 2006; 5: 64-69. http://dx.doi.org/10.1016/j.autrev.2005.07.001
Alkhalifah A1, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update: part I. Clinical picture, histopathology, and pathogenesis. J Am Acad Dermatol. 2010; 62(2): 177-88.
Navarini AA1, Nobbe S, Trüeb RM. Marie Antoinette syndrome. Arch Dermatol. 2009; 145(6): 656.
Petukhova L1, Duvic M, Hordinsky M, Norris D, Price V, Shimomura Y, Kim H, Singh P, Lee A, Chen WV, Meyer KC, Paus R, Jahoda CA, Amos CI, Gregersen PK, Christiano AM. Genome-wide association study in alopecia areata implicates both innate and adaptive immunity. Nature 2010; 466(7302): 113-7.
Richmond HM1, Lozano A, Jones D, Duvic M. Primary cutaneous follicle center lymphoma associated with alopecia areata. Clin Lymphoma Myeloma 2008; 8(2): 121-4. http://dx.doi.org/10.3816/CLM.2008.n.015
Kamada N, Hatamochi A, Shinkai H. Alopecia areata associated with myasthenia gravis and thymoma: a case of alopecia with marked improvement following thymectomy and high level prednisolone administration. J Dermatol 1997; 24: 769-772.
Izumi Y, Kinoshita I, Kita Y, Toriyama F, Taniguchi H, Motomura M, et al. Myasthenia gravis with diffuse alopecia areata and pemphigus foliaceus. J Neurol 2002; 249: 1455-1456. http://dx.doi.org/10.1007/s00415-002-0821-2
Mlczoch L, Attarbaschi A, Dworzak M, Gadner H, Mann G. Alopecia areata and multifocal bone involvement in a young adult with Hodgkin's disease. Leuk Lymphoma 2005; 46: 623-627. http://dx.doi.org/10.1080/10428190500032570
Busuttil DP. Alopecia areata universalis and acute lymphoblastic leukemia. Am J Hematol 2007; 82: 860. http://dx.doi.org/10.1002/ajh.20915
Wu MC, Yang CC, Tsai RY, Chen WC. Late-onset alopecia areata: A retrospective study of 73 patients from Taiwan. J Eur Acad Dermatol Venereol 2012.
Axel J, Weickert U, Dancygier H.[Gastrointestinal tumor (GIST) of the esophagus in a 34-year-old man: clubbed fingers and alopecia arealis as an early paraneoplastic phenomenon]. Dtsch Med Wochenschr 2005; 130: 2380-2383. http://dx.doi.org/10.1055/s-2005-918579
Molina Infante J, Hernández Alonso M, Martín Noguerol E, Pérez Gallardo B, Dueñas Sadornil C. Alopecia areata as the initial paraneoplastic presentation of gastric adenocarcinoma. Gastroenterol Hepatol 2009; 32: 128-30. http://dx.doi.org/10.1016/j.gastrohep.2008.09.007
Vesely MD, Kershaw MH, Schreiber RD, Smyth MJ. Natural innate and adaptive immunity to cancer. Annu Rev Immunol. 2011; 29: 235-71. http://dx.doi.org/10.1146/annurev-immunol-031210-101324
Hewagama A1, Richardson B. The genetics and epigenetics of autoimmune diseases. J Autoimmun 2009; 33(1): 3-11. http://dx.doi.org/10.1016/j.jaut.2009.03.007