Successful treatment of corticosteroid-resistant ophiasis-type alopecia areata (AA) with platelet-rich plasma (PRP).

T here are many clinical presentations and subtypes of alopecia areata (AA). One subtype, the ophiasis form, affects the occipital and parietal scalp and is often more resistant to treatment than AA monolocularis and AA multilocularis (ie, patchy AA). I present a case of a patient with corticosteroid-resistant ophiasis AA who had prompt regrowth with platelet-rich plasma (PRP) injections. A 41-year-oldwomanwithAA and bipolar disorder presented with concerns about poor response to intralesional triamcinolone acetonide injections (3 treatment sessions of 5 mg/mL; total 3 mL) and severe debilitating alterations in mood in the immediate weeks after each treatment session. Previous treatments includedminoxidil and topical steroidswithout effect. The patient did not wish to use systemic treatments nor contact therapy (diphencyprone, anthralin). A history of patchy AAwas present for over a decade but had been worsening in the past several years. Ophiasis-type AA was present for 2 years. Eyebrows, eyelashes, and nails were unaffected. Current medication included lithium, quetiapine, and lurasidone. Blood test results were normal, including platelet concentration 201 3 10/L, ferritin 72 g/L, and thyroid-stimulatinghormone3.42mIU/L. Treatment was administered with autologous PRP (Arthrex Angel System, Arthrex Inc, Naples, FL) at a concentration 3.5 times above baseline using a 2% hematocrit setting. The patient’s last steroid injection was 4 months prior. Briefly, 120 mL of blood was obtained from the patient using a 19-gauge butterfly needle and spun according to manufacturer’s