ALOPECIA UNIVERSALIS IN AN HIV-POSITIVE PATIENT - POSSIBLE INSIGHT INTO PATHOGENESIS

Alopecia universalis, a variant of alopecia areata, is a disease of un known etiology, though evidence for an autoimmune etiology continues t o mount. We report an HIV-positive patient with altered T-lymphocyte s ubsets in whom alopecia universalis developed. A skin biopsy of the pa tient's scalp demonstrated a classic perifollicular lymphocytic infilt rate, and immunophenotyping of the same specimen revealed that the maj ority of the cells were CD4+ lymphocytes. During the active loss of ha ir, the patient's CD4/CD8 ratio was decreased. This ratio normalized d uring the period of regrowth. Our data suggest that systemic immune dy sfunction, as seen in HIV infection, may be more important in mediatin g alopecia areata than localized immune responses. Given the proposed mechanism of alopecia areata developing in this patient, i.e. influx o f CD4+ lymphocytes to the perifollicular regions of skin when the CD4/ CD8 ratio is low, it is surprising that alopecia areata is not seen mo re commonly in patients with HIV infection.