Alopecia Following Oral Acyclovir for the Treatment of Herpes Simplex Keratitis
A 32-years-old female presented with complaints of redness, watering, photophobia, and diminution of vision in the left eye with duration of two weeks. She disclosed a history of a similar attack in the left eye one year previously. She had a visual acuity of 20/20 in the right eye and count fingers close to face in the left eye. Examination of the right eye did not reveal any abnormality. There was mild conjunctival congestion in the left eye. Slit lamp biomicroscopy showed corneal edema, medium-sized keratic precipitates, cells (++) and flare (++). Fluorescein staining of the cornea did not reveal any epithelial defect. There was a marked decrease of corneal sensation in the left eye. A diagnosis of keratouveitis due to recurrent herpes simplex virus infection in the left eye was considered. She was placed on prednisolone acetate (1%) suspension four times daily, atropine sulfate (1%) thrice a day, and oral acyclovir 400 mg twice-daily. At one week follow-up, there was decrease in her symptoms. The visual acuity in the left eye improved to counting fingers at three meters. Slit lamp biomicroscopy revealed mild corneal edema, decrease keratic precipitates, cells (+) and flare(+). She was advised to continue the same treatment. At three weeks, she felt symptomatically better, but complained of diffuse loss of hair from scalp. There was no history of drug eruptions. Her visual acuity in the left eye was 20/200. Slit lamp biomicroscopy revealed residual corneal opacity and few old keratic precipitates in the left eye. Examination of the scalp revealed a diffuse hair loss and no drug eruptions []. The color and the texture of the hair were normal.\nOral acyclovir was discontinued, and topical prednisolone was reduced to thrice a day for two weeks and then twice a day for two weeks. A follow up after three months of discontinuation of oral acyclovir revealed hair re-growth in the affected area on her scalp []. Examination of the left eye revealed a corneal opacity, and she was advised to undergo penetrating keratoplasty for the left eye. The patient was not on any other oral, topical or over-the-counter medication. In addition, she did not receive any holistic, natural or home remedies during this period. Patient was moderately-built and did not suffer from any nutritional deficiency. She had not been pregnant recently. In addition, she did not have any other systemic problem that may lead to hormonal imbalance. She did not suffer from lupus erythematosus, hypothyroidism, hyperthyroidism, syphilis, sarcoidosis, HIV infection or any systemic malignancy.