Azathioprine induced anagen effluvium and its association with myelosuppression

Dear Editor, Azathioprine, a steroid sparing immunosuppressant, is used in organ transplantation and various immunological diseases like pemphigus vulgaris, pemphigus foliaceous, vitiligo, lichen planus, and alopecia areata. Anagen effluvium (AE) is the abrupt loss of hairs in their growing phase most commonly due to chemotherapy and radiation 1. Azathioprine can cause AE in association with myelosuppression 2. A 20 year old married female presented to our department with extensive cutaneous and oral lesions and was diagnosed as pemphigus vulgaris based on clinical examination (Figure 1A) and histopathology.