Rapidly Progressive Alopecia Universalis after Varicella-Zoster Virus Infection: The role of Immune Dysregulation and Tofacitinib treatment

A nine-year-old boy presented with rapidly progressing hair loss following a severe case of chickenpox which required hospitalization due to the widespread lesions and cellulitis. The hair loss began as a small patch one week after discharge and progressed to alopecia universalis within two months, involving complete loss of scalp, eyebrow, eyelash, and body hair. Treatment with oral tofacitinib (2.5 mg every 12 hours) was initiated after comprehensive laboratory evaluations. After three months, the patient exhibited over 90% scalp hair regrowth, along with regrowth of eyebrows and eyelashes, and by nine months, he achieved complete hair regrowth without relapse. This case underscores a possible relationship between VZV infection and the onset of alopecia universalis. VZV-induced immune dysregulation, potentially through bystander activation disrupting T-cell and antigen-presenting cell responses, may have triggered an autoimmune response against hair follicles. The successful use of tofacitinib, a JAK inhibitor, suggests its value in managing VZV-associated alopecia areata by modulating immune responses.