Hair Loss Induced by Tumor Necrosis Factor Alpha Inhibitors

Abstract

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.

A Case of Refractory Cutaneous Sarcoidosis Successfully Treated with Infliximab

“…5 Despite several articles reporting TNF-alpha inhibitor-induced hair loss, our patient demonstrated hair regrowth in her frontal and vertex scalp after the initiation of infliximab infusion therapy. 6,7 The patient denied additional topical and systemic hair regrowth therapies following treatment. Although the mechanism of infliximab induced hair regrowth remains unknown, a study by Philpott et al showed that levels of IL-1β, IL-1α and TNF-alpha are potent inhibitors of hair follicle growth in vitro.…”