Although the association between alopecia areata (AA), psoriasis, and other 
autoimmune diseases has been well reported in the literature, an association 
with metabolic syndrome has not been reported. We present two young women with 
the combination of severe psoriasis, androgen excess, metabolic syndrome, 
thyroiditis, and AA. Both women ultimately progressed to treatment-resistant 
alopecia universalis. This constellation of autoimmunity and metabolic syndrome 
presents a therapeutic challenge while highlighting the need for full laboratory 
assessment of AA patients. Careful selection of biological treatment regimens 
may offer therapeutic benefit for both their psoriasis and AA while giving us 
experience with the newer biologics in AA.