Adalimumab-induced psoriasis of the scalp with diffuse alopecia: A severe potentially irreversible cutaneous side effect of TNF-alpha blockers

Shabrawi‐Caelen, Laila El; Plaça, M. La; Vincenzi, Colombina; Haidn, Thomas; Muellegger, Robert R.; Tosti, Antonella

doi:10.1002/ibd.20954

Cited by 55 publications

(46 citation statements)

References 7 publications

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“…Scalp psoriasis is usually characterized by discrete psoriatic plaques on the scalp, with or without alopecia, that may itch intensely [3, 4, 9, 10]. In contrast to palmoplantar pustulosis (where rheumatoid arthritis is the most common underlying disease), Crohn’s disease usually underlies the very rare manifestation of tumor necrosis factor alpha antagonist-induced scalp psoriasis.…”

Section: Discussionmentioning

confidence: 99%

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Severe Infliximab-Induced Alopecia and Scalp Psoriasis in a Woman with Crohn’s Disease: Dramatic Improvement after Drug Discontinuation and Treatment with Adjuvant Systemic and Topical Therapies

Udkoff

Cohen

2016

Dermatol Ther (Heidelb)

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Scalp psoriasis with alopecia is a rare cutaneous reaction to tumor necrosis factor alpha antagonists. This reaction often reverses with discontinuation of the offending drug and initiation of topical treatments; however, irreversible hair loss may occur if a scarring alopecia develops. We describe a woman with Crohn’s disease who developed scalp psoriasis and alopecia secondary to infliximab. She had a remarkable recovery after discontinuation of infliximab and treatment with oral minocycline and topical therapy: mineral oil under occlusion, betamethasone lotion, and sequential coal tar, salicylic acid, and ketoconazole shampoos each day. The patient’s alopecia completely resolved within 4 months of initiating this treatment regimen. In summary, early diagnosis of alopecia secondary to tumor necrosis factor alpha antagonist therapy is crucial in preventing diffuse alopecia and scalp psoriasis. In addition to discontinuing the offending agent, initiating aggressive adjuvant treatment with an oral antibiotic, topical therapies, or both, should be considered to reverse tumor necrosis factor alpha antagonist-induced alopecia and/or scalp psoriasis.

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Section: Discussionmentioning

confidence: 99%

“…This may result in skin or scalp lesions. Rarely, a scarring alopecia may develop; this reaction has only been described twice in the literature—both in patients being treated with adalimumab [3, 4]. We report a patient with Crohn’s disease being treated with infliximab who developed alopecia and scalp psoriasis.…”

Section: Introductionmentioning

confidence: 96%

Severe Infliximab-Induced Alopecia and Scalp Psoriasis in a Woman with Crohn’s Disease: Dramatic Improvement after Drug Discontinuation and Treatment with Adjuvant Systemic and Topical Therapies

Udkoff

Cohen

2016

Dermatol Ther (Heidelb)

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“…Seven were being treated for IBD, 4 with IFX, 69-71 and 3 with ADA. 6,71 All but one of these cases was associated with anti-TNF-induced psoriasis, an increasingly recognized side effect. Treatment with topical or intralesional steroid allowed continuation of treatment in some.…”

Section: Tnf-a Blocker Agentsmentioning

confidence: 98%

“…4 Only a single case of scarring alopecia associated with IBD has been reported to date, although this may represent underreporting. 6 The causes of focal nonscarring alopecia include alopecia areata (AA), infections such as tinea capitis, traction alopecia, and trichotillomania.…”

Section: Types Of Alopeciamentioning

confidence: 99%

Hair Loss in Patients with Inflammatory Bowel Disease

Patel

Farrant

Sanderson

et al. 2013

Inflammatory Bowel Diseases

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“…In addition to the scalp, these patients exhibited psoriatic lesions on the trunk, axillae, extremities, genitals, and palms/soles. The onset of hair loss ranged from two [43,44] to 46 [45] months after the TNF-α inhibitor was begun, with an average latency period of 8.6 months. There were 11 females and eight males.…”

Section: Clinical Subtypes Of Alopecia Seen During Treatment With Tnfmentioning

confidence: 99%

Hair Loss Induced by Tumor Necrosis Factor Alpha Inhibitors

Tosti¹

2014

J Clin Investig Dermatol

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Background: Alopecia is a possible adverse reaction to Tumor Necrosis Factor alpha (TNF-α) inhibitors. This side effect has become more recognized in recent years through FDA postmarketing surveillance and it description in case reports/case series. Objective:We review the literature and summarize the pathogenesis, clinical presentation, prognosis, and management strategies for TNF-α inhibitor induced alopecia. Methods:We performed a Medline search from January 1998 until August 2013 to identify all cases of alopecia during anti-TNF-α therapy described in the literature. We also reviewed FDA postmarketing data and clinical trials.Results: There were 62 cases of hair loss occurring during therapy with TNF-α inhibitors that we identified during our literature search. The causes of hair loss included alopecia areata, psoriatic alopecia, lichen planopilaris, drug-induced lupus erythematosus, androgenetic alopecia, and telogen effluvium. Alopecia was also a mentioned side effect in three clinical trials and in FDA postmarketing surveillance.Limitations: There are few controlled trials directly studying TNF-α inhibitor induced alopecia and most of our understanding of this clinical condition comes from anecdotal experience.Conclusions: TNF-α inhibitors can cause different types of hair loss including severe alopecia areata and scarring alopecia.

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Adalimumab-induced psoriasis of the scalp with diffuse alopecia: A severe potentially irreversible cutaneous side effect of TNF-alpha blockers

Cited by 55 publications

References 7 publications

Severe Infliximab-Induced Alopecia and Scalp Psoriasis in a Woman with Crohn’s Disease: Dramatic Improvement after Drug Discontinuation and Treatment with Adjuvant Systemic and Topical Therapies

Severe Infliximab-Induced Alopecia and Scalp Psoriasis in a Woman with Crohn’s Disease: Dramatic Improvement after Drug Discontinuation and Treatment with Adjuvant Systemic and Topical Therapies

Hair Loss in Patients with Inflammatory Bowel Disease

Hair Loss Induced by Tumor Necrosis Factor Alpha Inhibitors

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