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

Abstract

Scalp psoriasis with alopecia is a rare cutaneous reaction to tumor necrosis factor alpha antagonists. This reaction often reverses with discontinuation of the offending drug and initiation of topical treatments; however, irreversible hair loss may occur if a scarring alopecia develops. We describe a woman with Crohn’s disease who developed scalp psoriasis and alopecia secondary to infliximab. She had a remarkable recovery after discontinuation of infliximab and treatment with oral minocycline and topical therapy: mineral oil under occlusion, betamethasone lotion, and sequential coal tar, salicylic acid, and ketoconazole shampoos each day. The patient’s alopecia completely resolved within 4 months of initiating this treatment regimen. In summary, early diagnosis of alopecia secondary to tumor necrosis factor alpha antagonist therapy is crucial in preventing diffuse alopecia and scalp psoriasis. In addition to discontinuing the offending agent, initiating aggressive adjuvant treatment with an oral antibiotic, topical therapies, or both, should be considered to reverse tumor necrosis factor alpha antagonist-induced alopecia and/or scalp psoriasis.

<p>Therapeutic drug monitoring of biologics in psoriasis</p>

“…One example is benzo[b]thiophen-2-yl-3-bromo-5-hydroxy-5H-furan-2-one (BTH) which can reduce the proliferation of keratinocytes by inhibiting the anti-inflammatory activity of the NK-kB signalling pathway and impair STAT3 phosphorylation, preventing it from translocating to the nucleus and resulting in a decrease in keratinocyte proliferation 44. Other drug repositioning strategies to the following have been proposed: interleukin-1 β (eg, diacerein,41 glucosamine42), EGFR (eg, zalutumumab,43 panitumumab44,45), and VEGF (eg, bevacizumab,46 minocycline47).…”

Tumor necrosis factor-induced alopecia: alternative pathology and therapy

“…To the Editor: We commend the excellent report by Craddock et al that describes a 21-year-old woman with Crohn disease who developed tumor necrosis factor (TNF) inhibitor-induced alopecia secondary to adalimumab therapy [1]. We recently published a similar report [2] and have compared our experience with that of the authors.…”

The Association between Alopecia and Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

“…There are reports of 134 patients who developed alopecia as a side effect of IBD therapy (Table 4). Of those, 78 (58.2%) were on anti-TNF-α therapy (infliximab, adalimumab, certolizumab); 50 (37.3%) on thiopurine (azathioprine; 6-thioguanine), 4 (2.98%) on methotrexate, 1 (0.74%) on mesalamine, and 1 (0.74%) on sulfasalazine [3, 10, 13-16, 18-20, 25, 26, 29, 36, 37, 39-42, 44, 45, 50, 57, 60, 62, 64, 69-78, 80, 84-86, 88].…”

“…Of the 33 individuals described who discontinued IBD treatment, 7 (17.3%) experienced spontaneous hair regrowth; 8 (16%) required topical treatments, and 14 (60.8%) patients required a combination of both oral and topical regimen [13, 15, 17, 28, 31, 36-38, 40, 42, 46, 50, 57, 60, 62, 69, 72, 74, 78, 79, 83, 84].…”