Abstract
Objective and Background Alemtuzumab is a humanised monoclonal antibody against CD 52 with for highly aggressive multiples sclerosis with some undesirable side-effects. There have been few reports of skin disorders including the very rare alopecia universalis. We aim to report a case with this in long term follow up, explain the pathomechanisms and also present a comprehensive review of literature.
Methods We report a 36 year old male, started on alemtuzumab in 2015 and presented with Alopecia universalis in 2019. A systematic literature search in pubmed using the keywords "Alemtuzumab" "skin" "cutaneous" "alopecia" "hair loss" was done. Phase 3 studies and the side-effects during that time were also studied.
Results He started reporting isolated circular hairless areas in various regions of the body . Eventually, he lost hair all over his body with eyebrows being the last to go. He received baricitinib tablets, steroid injections and cyclosporin and is back to normal now at 9 years follow up. We have photographic evidence and a timeline of his evolution which we would like to present along with the hypothesized mechanisms.
Conclusion Due to the depletion of peripheral CD4 + and CD8 + T cells and initially of CD 19+ B cells, an increased risk of skin tumours after alemtuzumab is plausible. Our case report & review summarizes the mechanisms based on multiple case reports and series, highlights the need for registry data for such side-effects in large populations of MS who received alemtuzumab and emphasizes the need for multidisciplinary involvement in MS care.
