![]() ![]() The patient was advised to come for follow-up every month till the completion of 1 year. Besides, he was maintained on oral anti-diabetics comprising metformin and glipizide. About three such doses (cycles) were contemplated at intervals of 1 month each. The effect of administration of dextrose and concomitant NIDDM was neutralized by simultaneous administration of 16 units of human mono-component regular insulin. It comprised 100 mg of dexamethasone dissolved in 5% dextrose administered intravenously over 3-4 h on three consecutive days plus intravenous 500 mg of cyclophosphamide administered on day 2 only, followed by daily oral 50 mg cyclophosphamide. Moreover, side-effect profile is considered to be less severe with the pulse form than the conventional daily dosing of corticosteroids. The hematoxylin eosin stained biopsy section from the area of hair loss showed dense lymphocytic infiltrate in the dermis involving the receding remnant of hair follicles.ĭexamethasone cyclophosphamide pulse (DCP) therapy was opted for the treatment of extensive AA as it has successfully been used for bullous autoimmune dermatoses,, including pemphigus vulgaris. However, his random blood sugar was 197 mg (normal up to 140) and glycosylated hemoglobin (HbA1c) was 9.6 percent (normal 9%-10% fair glycemic control). Routine total and differential leukocyte count, complete hemogram and blood biochemical parameters were within normal limits. The complete loss of hair over the scalp was without any evidence of scarring or any skin lesion, which was characteristic of AA. Examination of the skin was marked by loss of hair over the whole of the skin surface of the trunk, upper and lower extremities with patches of hair loss over the beard area. The loss of hair over the scalp was total and was a source of embarrassment, which brought him for consultation. However, hair loss was not preceded by any perifollicular papular or pustular lesions. It was accompanied by mild to moderate itching. In a short period of time, hair loss was noticed over the trunk, scalp and the beard area. Four months later, he experienced spontaneous loss of hair over the legs progressing to involve other sites. The preceding treatment ensured complete healing of the boils within 2 weeks. His fasting and postprandial blood sugar levels were markedly elevated pointing to a diagnosis of NIDDM, for which oral anti-diabetics (metformin 500 mg + glipizide 5 mg), along with dietary advice and appropriate oral and topical antibiotics were started. ![]() Dexamethasone-cyclophosphamide pulse was initiated but failed to produce a response.Ī 47-year-old man, apparently well until a year ago had a few recalcitrant multiple boils on the nape of the neck. ![]() ![]() The development of alopecia areata (AA) progressing to totalis/universalis in well-established non-insulin-dependent diabetes mellitus (NIDDM, type II) is an exclusive phenomenon, an indirect circumstantial evidence favoring it as an autoimmune disease. Figure 1: Alopecia areata progressing to totalis/universalis: Complete loss of hair over the scalp ![]()
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