Alopecia areata is a common autoimmune disorder that often results in unpredictable hair loss, and sometimes can lead to complete hair loss on the scalp or entire body. Warfarin, an anticoagulant, can induce hair loss through its anti-mitotic and vasculature effects on hair follicles. Procainamide, an antiarrhythmic drug, may induce lupus through its effects on apoptosis, exposure of autoantigens, and generation of reactive metabolites. Ibuprofen can cause photosensitivity through absorption of UV/visible light and production of reactive oxygen species.

2. DEFINITION:
• Alopecia areata is a common autoimmune disorder that often results in
unpredictable hair loss. ... Sometimes, it can lead to the complete loss of hair
on the scalp (alopecia totalis) or, in extreme cases, the entire body (alopecia
universalis).
• https://www.medicalnewstoday.com/articles/70956.php

3. Class Genericname Brandname Dosageform
Anti-coagulant Warfarin Coagurin Oral (tab)
Anticonvulsant Valporic acid Neurol-ep Oral (tab)
Hormones Androgen AndroGel Topical (gel)
CNS stimulant Amphetamine Dyanavel Oral (tab)
Mood stabilizers Lithium Camcolit-400 Oral (tab)

4. Mechanism attributed to warfarin-induce hair fall includes;
• anti-mitotic effect on epithelial follicular growth
• Stimulation of epidermal proliferation
• inhibition of Epithelial bulb cell proliferation.
Another mechanism attributed to warfarin-induce hair loss includes;
• Change in vasculature of scalp
• Leading to focal degeneration of the connective tissues near the blood vessel of follicular
connective tissue sheath.
Reference:
https://innovareacademics.in/journals/index.php/ajpcr/article/download/18688/12574

6. Definition
• A chronic inflammatory condition caused by an autoimmune disease.
• An autoimmune disease occurs when the body’s tissues are attacked by its own
immune system.
• Patients with lupus have unusual antibodies in their blood that are targeted against
their own body tissues.
• Lupus can cause disease of the skin,heart,lungs,kidneys,joints and nervous
system.
• When only the skin is involved, the condition is called discoid lupus.
• When internal organs are involved, the condition is called systemic lupus.
http://www.medicinenet.com

7. Sr. No. GENERIC NAME BRAND NAME DOSAGE FORM
1 Anti-Arrhythmic
Procainamide
Pronestyl Tablets
2 Anti-Hypertensive
Hydralazine
Hydralazine Tablets
3 Anti-Convulsant
Carbamezapine
Tegral Tablets
Syrup
4 Anti-inflammatory
Sulphasalazine
Salazine Tablet
5 Diuretic
Hydrochlorthiazide
Advantec Tablets

8. Drug Inducing SLE-PROCAINAMIDE
• Drug metabolism and the interaction of drug metabolites with an altered immune system.
Induction Of Apoptosis
• Important role in Immune function such as the deletion of autoreactive T- and B-cells and the
removal of intracellular contents via phagocytosis to prevent the exposure of intracellular contents to
the immune system
• Apoptotic cells are a significant source of the auto antigens found in SLE
Interference withdisposal of apoptotic debris
• Lupus inducing drug interferes with the phagocytosis of apoptotic debris.
• Failure to remove autoreactive T- and B-cells and/or inducing apoptosis, may lead to the exposure
of the immune system to ordinarily sequestered intracellular components, as these cannot be
cleared effectively.

9. Metabolites of the drug exposedto oxidative metabolism
• Myeloperoxidase is activated. This interaction leads to formation of reactive
metabolites directly damaging the lymphocyte function. This reaction damages central T-cell
tolerance to the patient’s own tissues and regenerates autoimmune T cells against them.
• Reactive metabolites of procainamide have been shown to result in lupus-like
autoantibodies. This process may take a long time, months to years of drug exposure, for
symptoms to appear.
DiminishedT-cellMethylation
• Leads to an overexpression of lymphocyte function–associated antigen (LFA-1). T cells with hypo
methylated DNA turn into an auto reactive form and this process results in antibody formation.
• This mechanism leads to cutaneous ultraviolet Flares of Lupus Erythematous.
References:
• https://pdfs.semanticscholar.org/8c03/c953c3909deb4bc60e15749b15b5b74235ed.pdf
• https://www.lupusuk.org.uk/medical/gp-guide/diagnosis-of-lupus/associated-illnesses/drug-induced-
lupus/

10. • Sometimes referred to as a sun allergy, is an immune system reaction that is
triggered by sunlight. Sunlight can trigger immune system reactions.
• People develop itchy eruptions or areas of redness and inflammation on patches of
sun-exposed skin.

11. DRUGS GENERICNAME DOSAGEFORM BRANDNAME
NSAIDS (IBUPROFE,
NAPROXEN)
Ibuprofen Tablet Brufen
Cholesterol
lowering drugs (
simvastatin , )
Simvastatin Tablet Recol
Antibiotics Ciprofloxacin Tablet Ciproxin
Diuretics Furosemide Tablet Lasix

12. Mechanismof drug induce photosensitivity by ibuprofen
• Absorbs UV/or-visible radiations
• Decarboxylation of 2-aryl propionic acid occurs with subsequent free Radical activity
• In aerated system, The oxygen free radical is produced with high efficiency
• It is highly reactive towards lipids and proteins leading to free radical reactions causing
phototoxic or photo-allergic reactions
https://www.ncbi.nlm.nih.gov/pubmed/12020173