TNF inhibitor induced alopecia: an unusual form of psoriasiform alopecia that breaks the Renbök mold.
TNF-α-inhibitors are known to induce skin adverseeffects including psoriasis and alopecia areata. Here, wedescribe a unique pattern of hair loss that has psoriaticand alopecia areata-like features. Diagnosis requiresclinical-pathologic correlation and is supportedby increased catagen/telogen hairs, psoriasiformepidermal hyperplasia, perifollicular lymphocyticinfiltrate, and the presence of eosinophils and plasmacells. Although there are no treatment consensusguidelines, management options include stoppingtherapy, switching to a different TNF-α inhibitor orustekinumab (in severe cases), or continuing TNF-αinhibitor therapy with addition of topical, intralesional,or systemic immunosuppressants.
University of Wisconsin, Departments of Internal Medicine and Dermatology, Madison, Wisconsin. LCraddock@uwhealth.org.
Lauren N
LN
Craddock
David M
DM
Cooley
Justin O
JO
Endo
B Jack
BJ
Longley
Freddy
F
Caldera
D000068879:Adalimumab / Q000009:adverse effects*; D000505:Alopecia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D018501:Antirheumatic Agents / Q000009:adverse effects*; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D015552:Injections, Intralesional; D014221:Triamcinolone / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
D018501:Antirheumatic Agents; D005938:Glucocorticoids; D014409:Tumor Necrosis Factor-alpha; D014221:Triamcinolone; D000068879:Adalimumab