Anti-TNF-Alpha Induced Psoriasiform Eruptions with Severe Scalp Involvement and Alopecia: Report of Five Cases and Review of the Literature

The document described 5 cases of anti-TNF-α induced psoriasiform eruptions with severe scalp involvement leading to inflammatory alopecia. Topical therapy was effective in only 1 case, while the other 4 required systemic therapy (methotrexate ± cyclosporine). Among these, 3 patients discontinued anti-TNF-α treatment, resulting in 2 achieving clear/almost clear status and 1 showing mild improvement; the fourth patient switched anti-TNF-α but continued to experience flare-ups. No scarring alopecia was observed in these cases. A review of 15 total cases in the literature indicated that 9 patients discontinued anti-TNF-α and 9 received systemic therapy, with 2 developing scarring alopecia. The study concluded that while some patients may respond to topical treatment, severe cases should consider anti-TNF-α suspension and systemic therapy to prevent scarring alopecia.