Alopecia Areata Universalis Elicited during Treatment with Adalimumab

Abstract

Adalimumab is a fully humanized recombinant anti-tumour-necrosis-factor (TNF-α) monoclonal antibody which has been approved for rheumatoid arthritis, active ankylosing spondylitis, psoriatic arthritis and Crohn’s disease. We report a case of alopecia areata (AA) universalis occurring 6 months after administration of adalimumab monotherapy in a patient with a long-standing history of psoriatic arthritis and psoriasis. The diagnosis was confirmed by a scalp biopsy which showed a peribulbar infiltrate of both CD4+ and CD8+ T cells, CD1a+ dendritic cells as well as CD68+ and CD163+ macrophages. In addition, immunofluorescence staining for TNF-α was found in the mononuclear cell infiltrate. This case suggests a complex role of TNF-α in the induction of AA.

Alopecia Areata Universalis during Treatment of Rheumatoid Arthritis with Anti-TNF-α Antibody (Adalimumab)

“…In this respect, AA is frequently associated with other autoimmune diseases such as insulin-dependent diabetes, RA, vitiligo or Hashimoto's disease. The present observation together with that of Pelivani et al [2] suggests that adalimumab could trigger AA in predisposed individuals. The rapid development of AA in our patient may also be related to the interruption of methotrexate, an effective treatment of AA [5] , which was associated with adalimumab for 1 year prior to the onset of the disease.…”

“…We read with great interest the articles of Fabre and Dereure on 'Worsening alopecia areata and de novo occurrence of multiple halo nevi in a patient receiving infliximab' [1] and of Pelivani et al on 'Alopecia areata universalis elicited during treatment with adalimumab' [2] , and we want here to report on a similar observation of a rapidly progressive alopecia areata (AA) during treatment with adalimumab for rheumatoid arthritis (RA).…”

Three hundred and eight nanometer excimer light therapy for alopecia universalis that is resistant to other treatments: A clinical study of 11 patients

“…1 The incidence rates of the severe forms of AA such as alopecia totalis (AT) and alopecia universalis (AU) are lower and range 3.5-30% of all cases. 2 AU is usually resistant to therapy; therefore, further investigations into new treatments for the condition are needed. The 308-nm excimer light (equivalent to an excimer lamp) is a system that delivers long-wave monochromatic ultraviolet (UV)B radiation, which is known to induce T-cell apoptosis in vitro, 3 and has recently been reported to be useful for treating patchy AA in several clinical studies.…”

New Modalities in the Treatment of Refractory Alopecia Areata

“…As a result of the study, it was found as ineffective [79]. Several reports have been published indicating the development of AA during a treatment of anti-TNF-α for another disease [80][81][82][83][84][85][86]. Gorcey et al reported a patient with AU, refractory to various treatment modalities, who was successfully treated with adalimumab, while being treated for the flare of atopic dermatitis [87].…”