Certolizumab-Induced Paradoxical Psoriatic Alopecia

Abstract

<jats:sec><jats:title>Introduction:</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Case Presentation:</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Discussion:</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> 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. </jats:p></jats:sec>

Psoriatic Alopecia and Paradoxical Psoriasis Induced by Adalimumab Successfully Treated with Certolizumab: Clinical, Trichoscopic, and in vivo Reflectance Confocal Microscopy Features

“…Raquel Aragòn-Miguel et al [11] described the development of psoriatic alopecia-like paradoxical reaction in female patient with sacroiliitis 6 months after starting certolizumab pegol with complete resolution achieved by switching to ustekinumab. In addition, Ferraresso et al [12] described a case of scalp alopecia in a patient with Chron's disease who experienced hair regrowth after 4 weeks of treatment with topical steroids and discontinuation of certolizumab. Lauro W, et al [13] as well reported a case of psoriatic alopecia occurred in a patient suffering from psoriasis after 10 months of treatment with certolizumab pegol and resolved with the discontinuation of certolizumab pegol and pulsed therapy with oral dexamethasone combined with topical clobetasol lotion for 8 weeks.…”