Rituximab-Induced Alopecia Universalis in a Patient With Bullous Pemphigoid

Alopecia areata is a CD8+ T-lymphocyte driven autoimmune disorder leading to reversible hair loss. While most commonly presenting as isolated well-demarcated non-cicatricial alopecic patches on the scalp, subtypes of alopecia areata include alopecia totalis with loss of all scalp hair and alopecia universalis with complete loss of all body hair. Although primarily an idiopathic condition, several triggers, including medications, have been reported in the literature. To the best of our knowledge, we present the first reported case of rituximab, a chimeric anti-CD20 receptor monoclonal antibody, inducing alopecia universalis on two separate occasions during the treatment of bullous pemphigoid in a 55-year-old female. While the exact mechanism driving this association remains unclear, greater insights into the pathophysiology of alopecia areata/universalis may help to further explain this association and provide greater insight into other possible therapeutic options.J Drugs Dermatol. 2022;21(8):894-895. doi:10.36849/JDD.6690.