Childhood Alopecia Totalis: A Case and A Concise Review of The Available Evidence-Based Therapies.

In the modern medical literature, alopecia totalis has been reported as early as the 1940s. Childhood alopecia totalis is a heterogeneous disorder that occurs in syndromic and non-syndromic forms and can have autoimmune, nutritional and genetic bases. Non-syndromic childhood alopecia totalis is generally has autoimmune bases. During the 1970s, authors reported the treatment of alopecia totalis with DNCB which is 1-chloro, 2, 4-dinitrobenzene and High-dose glucocorticoid. Early during the 1980s, oral photochemotherapy was used in the treatment of alopecia totalis without the occurrence of side effects. The aim of this paper is to present a case of childhood non-syndromic alopecia totalis and to review of the available evidence-based therapies. The initial evidence-based treatment of a ten-year old boy with non-syndromic autoimmune alopecia totalis of more than two years that was considered refractory to treatments by at least three dermatologists is described. The family was referred to the pediatric psychiatry clinic as they no longer able to take the advice of any dermatologist and the child was clearly experiencing a psychologic upset that was disturbing the family life. Although many therapies have been tried during the previous two decades, no therapy is considered effective or satisfactory. However, in this case, the decision was made to use topical tofacitinib and topical minoxidil based on the available research evidence. However, topical tofacitinib was not available immediately, and the decision was made to use paste of raw garlic topically plus topical minoxidil. The boy was seen on the 27th of June, 2019, He had unexpectedly very scanty regrowth that contributed significantly to the improvement of the psychology of the boy and his parents. It can be useful to use the available research evidence to make some improvements in challenging cases.