Hair Loss Induced by Tumor Necrosis Factor Alpha Inhibitors

January 2014 in “ Journal of clinical and investigative dermatology ”

Antonella Tosti

Tumor Necrosis Factor alpha inhibitors TNF-α inhibitors alopecia areata psoriatic alopecia lichen planopilaris drug-induced lupus erythematosus androgenetic alopecia telogen effluvium alopecia scarring alopecia topical steroids

Studysummary This article reviews TNF-α inhibitor-induced alopecia, identifying various types of hair loss such as severe alopecia areata and scarring alopecia, and calls for more controlled studies to better understand this adverse effect.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

A decade ago, Lindsey and Tosti conducted a study that found Tumor Necrosis Factor alpha (TNF-α) inhibitors, drugs used to treat immune-mediated conditions, could cause various types of hair loss. They identified 62 cases of hair loss during therapy with TNF-α inhibitors from January 1998 to August 2013. The types of hair loss included alopecia areata, psoriatic alopecia, lichen planopilaris, drug-induced lupus erythematosus, androgenetic alopecia, and telogen effluvium. Alopecia was also mentioned as a side effect in three clinical trials and in FDA postmarketing surveillance. The researchers concluded that TNF-α inhibitors could cause severe alopecia areata and scarring alopecia, but noted a lack of controlled trials studying this condition. They recommended switching medication in patients with alopecia areata or psoriatic alopecia occurring during anti TNF-α therapy and suggested the application of topical steroids under occlusion.

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Research cited in this study

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

49 citations , January 2012 in “Dermatology”

In this study, only 1 out of 5 patients with anti-TNF-α induced psoriasiform eruptions showed good response to topical treatment, while systemic therapy and discontinuation of anti-TNF-α may prevent scarring alopecia in severe cases.

research Weight Gain and Hair Loss During Anti-TNF Therapy

16 citations , January 2012 in “International Journal of Rheumatology”

In this study, weight gain and hair loss were reported as adverse effects of anti-TNF therapy in patients with rheumatic diseases, leading some to discontinue treatment.

Psoriatic Alopecia/Alopecia Areata–Like Reactions Secondary to Anti–Tumor Necrosis Factor-α Therapy: A Novel Cause of Noncicatricial Alopecia

research Psoriatic Alopecia/Alopecia Areata–Like Reactions Secondary to Anti–Tumor Necrosis Factor-α Therapy: A Novel Cause of Noncicatricial Alopecia

72 citations , February 2011 in “The American Journal of Dermatopathology”

This study found that anti-TNF therapy-induced alopecia exhibits distinct clinical and histopathological features and can mimic psoriatic alopecia and alopecia areata, with some patients improving with topical treatment.

research Alopecia Areata as Another Immune-Mediated Disease Developed in Patients Treated with Tumor Necrosis Factor-Alpha Blocker Agents

61 citations , June 2010 in “Journal of the European Academy of Dermatology and Venereology”

This study highlights cases of alopecia areata that developed during anti-TNF-α therapy, suggesting a potential link or increased frequency, particularly among individuals with a personal or family history of autoimmune diseases.

research Alopecia Areata Following Adalimumab

38 citations , January 2009 in “Journal of Cutaneous Medicine and Surgery”

This case report highlights a woman who developed new-onset alopecia areata after starting adalimumab for psoriatic arthritis, challenging the assumed role of TNF-alpha in the condition's pathogenesis.