A case of malignant melanoma of the areola in a male patient

603 significant improvement in his quality of life. In particular, we noted a mild but significant increase in hair on the pubis (figure 1C), eyebrows, face, and scalp. The patient reported that the psoriasis began to improve after about 10 days of treatment, whereas the hair regrowth started after six weeks of therapy. In November 2017, the patient, of his own accord, discontinued secukinumab therapy due to complete resolution of psoriasis, and at a follow-up visit, in March 2018, he showed an initial recurrence of both psoriasis (PASI 1.8) and alopecia. The patient has not yet restarted systemic treatment. The efficacy of secukinumab for the treatment of psoriasis is well known [5]. Here, we report the effectiveness of secukinumab treatment on genital psoriasis and alopecia areata. Interleukin-17 has been shown to be involved in the pathogenesis of various inflammatory and autoimmune conditions [6, 7]. A possible role for IL-17+ T-helper cells in the pathogenesis of alopecia areata has been proposed [8], suggesting a rationale for the use of the IL-17 inhibitors in this disease. A small double-blinded, randomized prospective pilot study found that no patients in either the secukinumab or placebo groups met the primary endpoint, consistent with a 50% reduction in Severity of Alopecia Tool score (SALT50) at Week 24 [9]. Along with the possibility that Th17 is not pathogenic in alopecia areata, these authors hypothesized that the dose of secukinumab might have been insufficient, or the treatment duration too short to trigger the hair regrowth. Furthermore, the occurrence of alopecia areata has sometimes been reported among the side effects of some anti-interleukin drugs, including secukinumab and ustekinumab [10]. Although it is premature to draw any conclusion about the efficacy of secukinumab on alopecia areata based on a single case, both the improvement in hair growth upon secukinumab treatment and the recurrence of alopecia upon secukinumab discontinuation in our patient suggest a potential benefit of anti-IL-17 treatment in patients with severe and long-lasting alopecia areata, however, further and more extensive studies are needed to confirm this.