Alopecia secondary to anti-tumor necrosis factor-alpha therapy

Abstract

Biologic drugs represent a substantial progress in the treatment of chronic inflammatory immunologic diseases. However, its crescent use has revealed seldom reported or unknown adverse reactions, mainly associated with anti-tumor necrosis factor (anti-TNF). Psoriasiform cutaneous reactions and few cases of alopecia can occur in some patients while taking these drugs. Two cases of alopecia were reported after anti-TNF therapy. Both also developed psoriasiform lesions on the body. This is the second report about a new entity described as 'anti-TNF therapy-related alopecia', which combines clinical and histopathological features of both alopecia areata and psoriatic alopecia. The recognition of these effects by specialists is essential for the proper management and guidance of these patients.

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

“…The differential diagnosis of tumor necrosis factor alpha antagonist-induced hair loss includes alopecia areata, pityriasis amiantacea, psoriasis, and tinea capitis [11]. A retrospective review of drug reactions found infliximab to be the most common tumor necrosis factor alpha-antagonist to cause alopecia (18/52 cases, 35%) [12].…”

“…In addition to classic psoriasiform epidermal changes of idiopathic psoriasis, the histopathology of tumor necrosis factor alpha antagonist-induced psoriasis can also show alterations similar to alopecia areata. These may include hair follicle miniaturization, increased catagen and telogen hairs, and peribulbar lymphocytic infiltrate occupying all levels of the terminal hair structure [11]. …”

“…Topical corticosteroids, such as betamethasone 0.05% lotion and a daily shampoo with alternating agents (5% coal tar, 2% ketoconazole, and 6% salicylic acid) that are applied to the scalp can be used in the treatment of scalp psoriasis [11]. In addition, mineral oil followed by occlusion with a shower cap can promote the desquamation of the plaques.…”

Development of Alopecia During Treatment With a Tumor Necrosis Factor-Alpha Inhibitor in a Female Patient With Psoriatic Arthrits: A Clinical Case

“…В последние годы в связи с ростом использования ингибиторов ФНО-α стали встречаться случаи лекар-ственно индуцированной алопеции [17][18][19]. Данная потенциальная нежелательная реакция относится к числу наиболее редко встречающихся.…”

Cutaneous Adverse Reactions during Anti-Tnf Alpha Treatment for Inflammatory Bowel Diseases: The Experience of the Dermatology Clinic of Cagliari

“…Peculiar findings were the occurrence of a symptomatic photosensitivity, requiring active photo protection in two subject with IV to V Fitzpatrick phototype; an alopecia areata, and a hypertrichosis case, which are rarely reported controversial events [53][54][55][56][57].…”