A case report on azathioprine induced anagen effluvium, plica polonica, and bicytopenia in a patient of vitiligo.

Background: Anagen effluvium is described as abrupt hair loss during the anagen phase due to reduced follicular mitotic activity. Chemotherapeutic medicines, toxic metals, and sporadically bismuth, levodopa, colchicine, and cyclosporine are often implicated in etiology. Plica polonica is a rare disorder that develops when the scalp hair mats completely and abruptly, resulting in an extended stiff mass of hair that resembles dreadlocks.

Objective: We are describing this case because it is unusual to see plica polonica linked with azathioprine-induced pancytopenia in the literature and since the source of the condition was cuticular damage to the hair shaft as a result of the medication rather than carelessness or excessive bathing of the patient's hair.

Case Description: A 32-year-old lady presented to dermatology OPD, with vitiligo over bilateral forearm and lips for 6 months. She was started on azathioprine 50 mg daily for the past 1 month, and then she complained of sudden onset of extensive hair loss on attempting to comb her hair associated with matting of rest of uncombable hairs, multiple oral ulcers, and mild grade fever for 15 days. The possibility of systemic lupus erythematosus and azathioprine-induced anagen effluvium and neutropenic ulcers was thought.

Results: We started on injectable granulocyte colony-stimulating factor for 3 days, and antibiotics and antifungals for 1 week. Improvement in clinical (oral ulcers, fever) and hematological profiles were noted.

Conclusion: Although azathioprine is not often associated with the development of anagen effluvium, it is probable that the patient's abrupt pancytopenia caused damage to the hair shaft, which resulted in hair loss, and cuticular damage to the hair shaft, which led to the formation of Plica.