Abstract

Alopecia areata (AA) is an autoimmune disorder characterized by sudden onset, non-scarring hair loss, with exclamation-point hairs and/or cadaver hairs, and/or nail changes. Alopecia areata affects mainly people under 40 years, with a prevalence of 0.1 to 0.2%. It is associated with an increased risk of other autoimmune disorders. Symptoms of AA wax and wane, ranging from spontaneous remissions to alopecia totalis or universalis. The differential diagnoses of AA include but are not limited to tinea capitis, trichotillomania, TE, early stages of scarring alopecia, and alopecia neoplastica. Here we present a case of a 22-year-old female with a large bald patch on the scalp. The patient who suffers from major depression complained about losing hair over the last few months following Fluvoxamine treatment. Fluvoxamine-induced telogen effluvium (TE) was suspected. A skin biopsy was performed, and a histologic exam revealed a slightly decreased number of hair follicles with focal miniaturization. Most follicles were simultaneously in the catagen stage with a characteristic thickened catagenic basement membrane. Peribulbar lymphocytic infiltrate ("swarm of bees") without scaring was also present. PAS stain was negative for fungal infection, and elastic stain visualized preserved elastic fibers in the dermis. The histologic findings are consistent with AA, not TE. Alopecia, mostly TE, is a well-known adverse effect of SSRIs (selective serotonin reuptake inhibitor), including fluvoxamine. Fluvoxamine-induced AA has not been reported previously. Published data show that serotonin plays a vital role in the pathogenesis of AA, suggesting a possible link between SSRIs treatment and AA.

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