Alopecia Universalis: An Extremely Rare but Probable Adverse Effect of Adalimumab

A 50-year-old male with psoriasis and psoriatic arthritis developed alopecia universalis (AU) after one year of biweekly adalimumab injections, despite improvement in his primary conditions. Trichoscopy confirmed AU, and the patient was switched to etanercept, which managed his psoriasis and arthritis but did not result in hair regrowth after six months. The exact mechanism of adalimumab-induced hair loss was unclear, but the patient's autoimmune background and the immunomodulatory effects of adalimumab were considered potential triggers. The Naranjo scale score of 7 indicated a probable adverse drug reaction. The case underscored the need for further research on the duration and reversibility of this side effect and the importance of educating patients about this potential risk.