title: Alopecia areata universalis elicited during treatment with adalimumab.
abstract: Adalimumab is a fully humanized recombinant anti-tumour-necrosis-factor (TNF-alpha) monoclonal antibody which has been approved for rheumatoid arthritis, active ankylosing spondylitis, psoriatic arthritis and Crohn's disease. We report a case of alopecia areata (AA) universalis occurring 6 months after administration of adalimumab monotherapy in a patient with a long-standing history of psoriatic arthritis and psoriasis. The diagnosis was confirmed by a scalp biopsy which showed a peribulbar infiltrate of both CD4+ and CD8+ T cells, CD1a+ dendritic cells as well as CD68+ and CD163+ macrophages. In addition, immunofluorescence staining for TNF-alpha was found in the mononuclear cell infiltrate. This case suggests a complex role of TNF-alpha in the induction of AA.
authors.affiliation: Department of Dermatology, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Nedzmidin
authors.initials: N
authors.lastname: Pelivani
authors.forename: Akmal S
authors.initials: AS
authors.lastname: Hassan
authors.forename: Lasse R
authors.initials: LR
authors.lastname: Braathen
authors.forename: Robert E
authors.initials: RE
authors.lastname: Hunger
authors.forename: Nikhil
authors.initials: N
authors.lastname: Yawalkar
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000506:Alopecia Areata / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000097:blood / Q000276:immunology / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab