Adalimumab‐induced scalp psoriasis with severe alopecia as a paradoxical effect in a patient with Crohn's disease successfully treated with ustekinumab

Koumaki, Dimitra; Koumaki, Vasiliki; Katoulis, Alexander; Lagoudaki, Eleni; Boumpoucheropoulos, Sotirios; Stefanidou, Maria; Miaris, Orestis; Baltaga, Ludmila; Evangelou, George; Zografaki, Kyriaki; Krueger-Krasagakis, Sabine; Krasagakis, Konstantinos

doi:10.1111/dth.13791

Cited by 6 publications

(5 citation statements)

References 9 publications

(9 reference statements)

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“…2 The most characteristic pattern of psoriasis associated with TNFi is a localized eruption resembling palmo-plantar psoriasis or pustulosis 5 while exacerbation of scalp psoriasis is a less common manifestation. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Here we describe 6 new cases and a literature review of previously reported cases with acute exacerbation or de novo appearance of TNFi-induced severe scalp psoriasis accompanied with hair loss. Paradoxical TNFi-induced psoriasis, namely the occurrence of psoriasis following treatment with TNFi agents that are usually used to treat psoriasis, is explained in part by cytokine imbalance with increased production of interferon-alpha.…”

Section: Discussionmentioning

confidence: 99%

“…Twenty-eight cases of severe scalp psoriasis accompanied by extensive hair loss induced by TNFi therapy have been reported [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] (for details see supplementary Table 1). Altogether, in the literature and in our series, most of the patients were women (79%) with a previous diagnosis of Crohn's disease (76%).…”

Section: Literature Review and Data Analysismentioning

confidence: 99%

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Scarring Alopecia in Tumor Necrosis Factor-α Antagonists-Induced Scalp Psoriasis

Baniel

Peled

Samuelov

et al. 2023

Journal of Psoriasis and Psoriatic Arthritis

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Background A broad spectrum of adverse reactions associated with the use of tumor necrosis factor alpha (TNFα) antagonists has been recognized over the past years. Induction of scalp psoriasis is a less known undesirable consequence of the use of these drugs and is not well characterized. Objective To characterize TNFα inhibitors-induced psoriatic alopecia. Methods We studied 6 patients with TNF-inhibitor induced psoriatic alopecia and reviewed 28 patients with this condition reported in the literature to date. Results In addition to severe scalp psoriasis, we report hair follicle pathologies ranging from alopecia areata to scarring alopecia. Prognosis was good, but discontinuation of TNFα inhibitors was required in more than half of the cases in order to achieve a favourable outcome. Conclusion TNFα inhibitors-associated psoriatic alopecia is rarely reported but requires a high index of suspicion and prompt diagnosis, as timely intervention may prevent irreversible damage.

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Section: Discussionmentioning

confidence: 99%

Section: Literature Review and Data Analysismentioning

confidence: 99%

Scarring Alopecia in Tumor Necrosis Factor-α Antagonists-Induced Scalp Psoriasis

Baniel

Peled

Samuelov

et al. 2023

Journal of Psoriasis and Psoriatic Arthritis

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“…3,20 infiltrates. 21,22 Education of other specialists and patients about this presentation may facilitate early diagnosis, while avoiding empirical treatments of presumed tinea capitis or other causes of non-scarring alopecias. There is a relative paucity of TNFα-induced guttate psoriasis, with only 4.2% of patients affected in our study, whereas guttate psoriasis is the second most prevalent morphology among pediatric patients, where 30% of patients report this morphology.…”

Section: Discussionmentioning

confidence: 99%

“…TNF‐α inhibitor–induced alopecia is typically non‐cicatricial, but may progress to permanent hair loss, especially if untreated 3,20 . TNF‐α inhibitor–induced alopecia shows unique histopathologic features including atrophy of the sebaceous lobules, as well as eosinophil and plasma cell infiltrates 21,22 . Education of other specialists and patients about this presentation may facilitate early diagnosis, while avoiding empirical treatments of presumed tinea capitis or other causes of non‐scarring alopecias.…”

Section: Discussionmentioning

confidence: 99%

Paradoxical psoriasis in pediatric patients: A systematic review

Cyrenne

Parpia

Sibbald

2021

Pediatric Dermatology

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Background: Paradoxical psoriasis occurs in pediatric patients following treatment with biologic agents. These presentations are not well described, and optimal treatment strategies have not been established. Objective:To describe the reported rates, demographic characteristics, clinical presentation, and treatment options for TNFα inhibitor-induced psoriasis.Methods: Systematic review of published cases and cohort studies of paradoxical psoriasis induced by biologic agents, with specific reference to TNFα inhibitors. Results:We identified 4564 pediatric patients treated with TNFα inhibitors, of whom 210 (4.6%) developed paradoxical psoriasis. Infliximab was the drug most likely to induce psoriasis (8.3%), followed by adalimumab (3.3%). Individual-level data were acquired from 129 individuals with a mean age of 13.6 years (SD: 4.0); 45.0% were male. The scalp was the most commonly affected area (47.5%), followed by the ears (30.8%). Most (63.3%) patients were continued on TNFα inhibitor therapy. Among those who switched TNFα inhibitors, only 32.0% had complete clearance of their skin lesions. Among patients who were switched to a non-TNFα inhibitor, 81% had complete clearance of their paradoxical psoriasis.Limitations: Data were acquired from retrospective studies including case reports and case series. Conclusion:TNFα inhibitor-induced psoriasis is a common adverse effect; however, most patients can continue their original therapy and be managed with skin-directed topical or systemic medications. If a patient requires medication discontinuation, switching to a new TNFα inhibitor is unlikely to lead to resolution of their skin lesions.

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“…In addition, topical corticosteroids proved effective in a case of pustular psoriasis associated with infliximab [ 75 ]. A few cohort studies reached a consensus that the replacement of TNF-α inhibitor with another biologic, especially ustekinumab, is beneficial to PP [ 77 , 78 ]. Moderate-to-high anti-nuclear antibody titers and extensive pustular presentations may be negative prognostic indicators in PP patients [ 79 ].…”

Section: Management Of Ppmentioning

confidence: 99%

Paradoxical psoriasis: The flip side of idiopathic psoriasis or an autocephalous reversible drug reaction?

Lu,

2023

Journal of Translational Autoimmunity

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Adalimumab‐induced scalp psoriasis with severe alopecia as a paradoxical effect in a patient with Crohn's disease successfully treated with ustekinumab

Cited by 6 publications

References 9 publications

Scarring Alopecia in Tumor Necrosis Factor-α Antagonists-Induced Scalp Psoriasis

Scarring Alopecia in Tumor Necrosis Factor-α Antagonists-Induced Scalp Psoriasis

Paradoxical psoriasis in pediatric patients: A systematic review

Paradoxical psoriasis: The flip side of idiopathic psoriasis or an autocephalous reversible drug reaction?

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