Case of psoriasiform and pustular eruptions in addition to alopecia as a paradoxical reaction induced by infliximab

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

“…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.…”

“…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%).…”

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

“…Rarely, it can be accompanied by psoriasiform, noncicatricial scalp alopecia (Table 1). 1‐8 Shimokata et al showed that in psoriasiform scalp alopecia, there are infiltrations of CD4‐ and CD8‐positive T lymphocytes into follicles that were involved in follicular destruction provoking alopecia 8 . In a case of alopecia occurring during treatment with anti‐TNF‐α, we recommend anti‐TNF‐α treatment withdrawal.…”

Paradoxical Pustular Psoriasis Following Treatment of Chronic Plaque Psoriasis with Ustekinumab

“…In the fifth case, a 30-year-old patient with psoriasis was treated with Ustekinuma instead of Infliximab, and developed pustular psoriasis 2 weeks after the second injection of Ustekinumab [10]. A review of relevant literature found that infliximab has also been reported to induce pustular psoriasis [11]. Antitumor necrosis factor-induced psoriasis may be caused by a decrease in TNF-α and an increase in production of plasma cell-like dendritic cell interferon -A (IFN-A).IFN-A can indirectly promote the activation of T cells through the activation of myeloid dendritic cells, or directly promote the activation of T cells through IFN-A sensitive T cells, so that T cells can accumulate locally in the skin and cause local psoriatic changes [12].…”