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Introduction: Biologic drugs have revolutionized the treatment of chronic inflammatory immunologic diseases. However, their use is associated with adverse reactions, including paradoxical adverse events. Tumor necrosis factor (TNF)–associated psoriatic alopecia (TiAPA) is a paradoxical adverse event that has been rarely reported in the literature. Only 1 case secondary to certolizumab has been recently described. Case Presentation: We described a case of scalp alopecia secondary to certolizumab in a 27-year old female patient with Crohn disease. The skin biopsy showed psoriasiform changes and loss of sebaceous lobule compatible with TiAPA. The patient presented significant improvement in the clinical findings and hair regrowth after 4 weeks of treatment with clobetasol unguent 0.05% and discontinuation of certolizumab. Months later she received infliximab for her Crohn disease, achieving good control of the illness until today. Discussion: This is a paradoxical adverse event that has been rarely reported in the literature. Most of the cases were related with infliximab and adalimumab. There is no standard approach for the management of TNF inhibitor–induced psoriasis, but around 20% require discontinuation of treatment. Conclusions: The recognition of anti-TNF drug–induced alopecia has allowed description of a new form of alopecia, clinically and histologically mimicking primary psoriatic alopecia with the recently described finding of loss of sebaceous lobules. Recognizing this form of alopecia can enable effective treatment while allowing, in most cases, anti-TNF therapy to continue.

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BackgroundBehçet’s disease (BD) is characterised by recurrent oral and/or genital ulcers accompanied by ocular, cutaneous, articular, gastrointestinal, and/or neurologic manifestations. Oral and/or genital aphthous ulcers are often refractory to conventional treatment. Apremilast is an orally-active small molecule which inhibits phosphodiesterase-4 (PDE-4) that modulates some inflammatory pathways.ObjectivesOur aim was to assess the efficacy of apremilast in BD patients with oral and/or genital ulcers refractory to conventional treatment.MethodsRetrospective national multicenter open-label study on 19 BD patients treated with apremilast at standard dose of 30 mg twice daily. The main outcome was achievement of oral ulcers remission.ResultsWe included 19 patients (14 women and 5 men) with a mean age of 43.6±14.8 years. Before apremilast, all patients had also received several systemic conventional drugs: oral corticosteroids (n=18), colchicine (n=19), NSAIDs (n=10), methotrexate (n=10), azathioprine (n=10), cyclosporine (n=6), infliximab (n=3), adalimumab (n=5), dapsone (n=3), etanercept (n=1), mycophenolate mofetil (n=1), tocilizumab (n=1). The main clinical symptoms for starting apremilast were oral aphthous ulcers (n=19) and genital ulcers (n=14). Other manifestations present at apremilast onset were arthralgia/arthritis (n=6), folliculitis/pseudofolliculitis (n=6), asthenia (n=5), furunculosis (n=1), erythema nodosum (n=1), erythematosus and scaly skin lesions (n=1), psoriasis (n=1), deep venous thrombosis (n=2) and ileitis (n=1). Table 1 shows the evolution of the patients. After a median follow-up of 6 [interquartile range, 5–10] months, most of the patients experienced clinical improvement. In this period of time, 11 patients developed any side-effect: dyspepsia (n=5), nauseas (n=4), diarrhoea (n=4), abdominal pain (n=4), headache (n=3), loss of appetite (n=3), weight loss (n=1) and halitosis (n=1). Three patients had to reduce the dose to 30 mg/day. Apremilast was discontinued in 4 patients: because of not obtaining the expected improvement (n=2), due to desire of pregnancy (n=1) and due to development of neurological involvement (n=1).Abstract FRI0489 – Table 1ConclusionsApremilast leads to a rapid and maintained improvement in many patients with refractory mucocutaneous ulcers of BD. Even in patients refractory to several systemic drugs including biologic therapy. However, the development of adverse digestive effects is frequent.Disclosure of InterestNone declared