Tumor necrosis factor-induced alopecia: alternative pathology and therapy

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%).…”

Treatment of Crohn's Disease and Concomitant Alopecia Areata With Tofacitinib

“…1,2,4,10,11 Meanwhile, several reports suggest that TNF-a antagonists might be a trigger for alopecia. [6][7][8][9] A retrospective cohort study including 917 consecutive patients with IBD who initiated TNF-a antagonists showed that 264 patients (29%) developed skin lesions and only 5 patients (4 CD and 1 ulcerative colitis) developed new-onset alopecia after a median 2.2 years of TNFa therapy. 12 Pathological characteristics of TNF-a antagonistinduced alopecia were reported as psoriasiform changes or folliculitis decalvans.…”

“…However, TNF-a antagonists sometimes induce new-onset AA. [6][7][8][9] We present a patient with CD treated with adalimumab who developed AA that progressed to alopecia totalis and universalis. Tofacitinib successfully treated her hair loss and maintained her CD.…”

Alopecia areata induced by A dalimumab in a patient with C rohn's disease

“…5,6 Even though TNF-α is a factor inducing, TNF-α inhibitors have also paradoxically been associated with new cases of AA. 7 How AA may develop during the treatment with TNF-α inhibitors is yet to be clarified; there is proof that blocking TNF-α could increase the production of IFN-α through plasmacytoid dendritic cells, thus increasing lymphocyte T cells activation and proliferation. 8,9 Indeed, In conclusion, despite the rising interest in biotechnological drugs and particularly in the TNF-α inhibitors, an increasing number of unexpected reactions to such treatments has been reported.…”