Recurrence of Alopecia Areata in a Patient Receiving Etanercept Injections

Abstract

Background: Alopecia areata is a common condition of patchy hair loss that has been postulated to have an autoimmune pathogenesis involving inflammatory cytokines, including tumor necrosis factor (TNF) ␣. Etanercept is a novel medication that blocks TNF-␣-mediated processes. We report a case involving the recurrence of alopecia areata in a patient receiving etanercept.Observations: We describe a 49-year-old man with a history of rheumatoid arthritis and alopecia areata who developed a recurrence of his alopecia areata while being treated with etanercept for more than 2 years. Conclusions:The anti-TNF-␣ effect of etanercept therapy may not be sufficient to prevent the recurrence of alopecia areata. The possible role of TNF-␣ in the pathogenesis of alopecia areata may be called into question if our observation is repeated.

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

“…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.…”

Failure of Two TNF‐α Blockers to Influence the Course of Alopecia Areata

“…Given that the pathogenesis of AA involves TNF‐α, we find it disappointing that TNF‐α inhibition, successful enough to effectively treat psoriasis, failed to regrow hair in our patient. This supports the contention that TNF‐α may not be an essential mechanism for AA and that other cytokines should be targeted with their respective inhibitors 3 . It is possible that blocking one specific or a particular combination of cytokine(s) could provide the desired results, but the AA essential cytokine(s) has not yet been identified.…”

“…The few reported cases including the one presented herein, have shown either recurrence of AA during TNF‐α inhibitor therapies 3 or complete failure to respond 14 . Given that the pathogenesis of AA involves TNF‐α, we find it disappointing that TNF‐α inhibition, successful enough to effectively treat psoriasis, failed to regrow hair in our patient.…”

Alopecia areata in a patient with psoriatic arthritis and Crohn's disease receiving etanercept

“…The literature reports occasional cases of alopecia areata during anti-TNF-a treatment. [5][6][7] The present report underlines the complex and unclear role of TNF-a in the pathogenesis of alopecia areata, as reported in the literature. An increased expression of IL-1b, interferongamma, IL-2 and TNF-a has been demonstrated in alopecia areata lesions.…”