Alopecia universalis during treatment with leflunomide and adalimumab - Case report

Lazzarini, Rosana; Capareli, Gabriela Cunha; Buense, Roberta; Lellis, Rute Facchini

doi:10.1590/abd1806-4841.20142944

Cited by 15 publications

(10 citation statements)

References 8 publications

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“…The development of AA during treatment with TNF-i such as adalimumab for psoriasis has been previously reported 3 . Our case extends the very recently reported association of adalimumab in rheumatoid arthritis with AU to the occurrence of the same ADR with the use of adalimumab in psoriatic arthritis, another autoimmune rheumatic disease 4 . More so, AU can be considered a class-effect of TNF-i because it did not reverse with the use of etanercept that belongs to the same class (TNF-i) with a different molecular structure.…”

Section: Discussionsupporting

confidence: 88%

Alopecia Universalis: an extremely rare but probable adverse effect of adalimumab

Kadam¹,

Kaushik²

2014

iosrphr

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Objective: To report alopecia universalis (AU) as an adverse effect of adalimumab that has not yet been documented in literature. Case Summary: A 50-year-old male was diagnosed with psoriasis and psoriatic arthritis and was commenced on adalimumab subcutaneous injections biweekly. The psoriatic skin lesions and arthritis showed improvement. However, one year later he lost all his body hair including pubic hair. Trichoscopy confirmed AU. Adalimumab was believed to have caused this adverse drug reaction (ADR). He was switched to etanercept with a good response (psoriasis and psoriatic arthritis). However he had no evidence of hair regrowth six months after change of therapy. Discussion: The exact pathogenesis of adalimumab causing hair loss is poorly understood. The patient's history of psoriasis and psoriatic arthritis conferred an autoimmune diathesis. Adalimumab with its immunomodulatory properties might have been the potential trigger for the development of AU with a sustained or even a permanent injury to the hair follicle as evidenced by absence of hair regrowth at 6-month follow up. Our patient scored a 7 on the Naranjo scale, which signifies that an ADR is the probable cause of AU. Conclusion: This case highlights that AU is a probable ADR of adalimumab. Further studies are needed to assess the duration and reversibility of hair loss. Patients should be promptly educated regarding its occurrence prior to commencement of therapy in order to minimize any associated psychological impact.

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Section: Discussionsupporting

confidence: 88%

Alopecia Universalis: an extremely rare but probable adverse effect of adalimumab

Kadam¹,

Kaushik²

2014

iosrphr

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“…However, this paradoxical reaction also suggests that it might be possible that autoimmunity is mediated by blockade of regulatory T cells. [131415] Hence, our case along with observation of Lazzarin et al .,[16] Posten and Swan,[17] Strober et al .,[18] Pelivani et al . [19] indicate that etanercept can trigger alopecia in predisposed individuals.…”

Section: Discussionsupporting

confidence: 81%

Alopecia universalis in a case of rheumatoid arthritis after treatment with etanercept

Kandpal¹

2019

Int J Trichol

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Alopecia universalis (AU) is a condition which causes generalized hair loss of the body. It is postulated that autoimmunity plays an important role in its pathogenesis. It is characterized by the involvement of multiple inflammatory cytokines such as tumor necrosis factor-alpha and multiple interferons. Hence, biologics like tumor necrosis factor alpha (TNF-α) antagonist may be used to block this inflammatory process. It is not very commonly appreciated that the use of biologics can lead to alopecia areata. Here, we report a case of severe alopecia areata which progressed to AU after etanercept administration. We here describe a 23-year-old unmarried female who was a known case of rheumatoid arthritis who developed AU after 6 months of continuous treatment with etanercept. TNF-α antagonist may not play a sufficient role in the treatment of alopecia areata. There exists a strong and significant connection between TNF-α blockers and development of alopecia and specifically AU and their role in the pathophysiology of the disease should be called into question if our findings are observed again.

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“…In the last few years, several biologic drugs, especially TNF blockers, have demonstrated efficacy in a variety of immune‐mediated inflammatory diseases (IMIDs) including AA 3 . However, cases of AA and alterations in the immune system during these therapies have been recently described 1–4 . We report herein four cases of AA occurring during treatment with different biologic drugs for IMIDs and discuss future directions on this novel therapy.…”

Section: Figurementioning

confidence: 98%

“…Alopecia areata (AA) is a chronic immune‐mediated condition with a still unknown pathogenesis, although genetics and environmental triggers have been implicated thus far 1 . Proinflammatory cytokines such as tumor necrosis factor‐alpha (TNF‐α) and interferon‐gamma (INF‐γ) are thought to induce immune system activation against the hair follicle 2 .…”

Section: Figurementioning

confidence: 99%

Alopecia areata and novel biologic agents: report of four cases and future directions

et al. 2021

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Alopecia universalis during treatment with leflunomide and adalimumab - Case report

Cited by 15 publications

References 8 publications

Alopecia Universalis: an extremely rare but probable adverse effect of adalimumab

Alopecia Universalis: an extremely rare but probable adverse effect of adalimumab

Alopecia universalis in a case of rheumatoid arthritis after treatment with etanercept

Alopecia areata and novel biologic agents: report of four cases and future directions

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