Influence of the human activity in the Atlantic Forest and in the prevalence of etiological agents of dermatophytosis in a coastal city of Southern Brazil [Ubatuba (São Paulo)]

Similar cases of AA sparing lesional white hairs like our case have not been reported since then. This case assumes unique presentations characteristically affecting pigmented hairs in the hair loss patch and exclamation hair was also pigmented. The remaining graying hairs within the hair loss patch were firmly attached to the scalp and showed the same texture and diameter with the normal pigmented hair except with disappearance of melanin deposit in the hair medulla. The patient denied any autoimmune diseases such as thyroid disease and vitiligo. All these findings mounted to the diagnosis of AA. We believe this feature may add a new subtype of AA and deserved our investigation. The pathogenesis of this unique presentation of AA remains elusive. The association of AA with autoimmune disease, the finding of an inflammatory infiltrate on histopathologic examination, and the hereditary nature of the disease suggests an autoimmune pathogenesis. Collective evidence point to follicular melanocytes as a possible important target in the autoimmune process of AA. 5 Follicular melanocytes in AA show both histological and ultrastructural abnormalities. Using the human scalp explant/severe combined immune deficiency (SCID) mouse transfer model, Gilhar et al . demonstrated that melanocyte-associated T-cell epitopes are capable of functioning as autoantigens to induce AA in the human scalp grafts/SCID mouse model. Melanocyte HLA-A2restricted peptides can activate T-cells for transfer of AA to autologous scalp skin grafts on SCID mice, indicating that melanocyte-associated autoantigens can be pathogenic and epitope spreading is likely to have a role in the broad nature of the antimelanocyte response. 6 The patients had received 1 year treatment with 2% minoxidil without hair regrowth, indicating its unfavorable prognoses with such a clinical appearance.