Anti-TNF-Alpha Induced Psoriasiform Eruptions with Severe Scalp Involvement and Alopecia: Report of Five Cases and Review of the Literature

Osório, Filipa; Magro, Fernando; Lisboa, Cármen; Lopes, Susana; Macedo, Guilherme; Bettencourt, Herberto; Azevedo, F; Magina, Sofia

doi:10.1159/000342503

Cited by 44 publications

(52 citation statements)

References 25 publications

(28 reference statements)

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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%

“…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. A case series and literature review reported 15 such individuals; 80% (12/15) of the patients had a history of Crohn’s disease [10]. …”

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%

Section: Discussionmentioning

confidence: 99%

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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“…The authors also described lichenoid lesions and pustular folliculitis [18]. Osório et al [19] described 5 cases of anti-TNFα-induced psoriasiform eruptions with severe scalp involvement. Doyle et al [20] described 3 patients who developed psoriasiform lesions on the scalp after the use of anti-TNF drugs.…”

Section: Discussionmentioning

confidence: 99%

Eczema-Like Psoriasiform Skin Reaction due to Brazilian Keratin Treatment

Gavazzoni-Dias

Rochael

Vilar

et al. 2015

Skin Appendage Disord

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The use of formaldehyde and formaldehyde releasers in hair-straightening formulations started in Rio de Janeiro in 2003. The technique is known as BKT, Brazilian keratin treatment. The aim of this study was to analyze the types of skin reactions presented by patients due to BKT. We describe 7 patients with severe erythema and scurf on the scalp which developed shortly after BKT. The lesions were eczema-like psoriasiform, located mainly on the scalp. Some patients also developed eczema-like lesions and pustules on the face, neck, upper arms, and upper trunk. Dermatoscopic findings included erythema, perifollicular and interfollicular scurf. The peripilar desquamation resembled the outer skin of an onion bulb. Scalp biopsies revealed psoriasiform and spongiotic psoriasiform patterns, one of them similar to anti-TNFα biologic drug psoriasiform alopecia. The possible consequences of the absorption of formaldehyde by hairdressers or clients are still to be verified by the scientific community; however, the skin and scalp reactions observed in our cases suggest a drug reaction phenomenon and not only eczemas of irritant or allergic origin.

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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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Anti-TNF-Alpha Induced Psoriasiform Eruptions with Severe Scalp Involvement and Alopecia: Report of Five Cases and Review of the Literature

Cited by 44 publications

References 25 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

Eczema-Like Psoriasiform Skin Reaction due to Brazilian Keratin Treatment

Hair Loss Induced by Tumor Necrosis Factor Alpha Inhibitors

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