TNF-Inhibitor Associated Psoriatic Alopecia: Diagnostic Utility of Sebaceous Lobule Atrophy

March 2017 in “ Journal of cutaneous pathology ”

Olga K. Afanasiev, Cathryn Z. Zhang, Steven M. Ruhoy

TNF inhibitor psoriatic alopecia sebaceous lobule atrophy scalp alopecia Crohn's disease inflammatory arthritis scalp biopsies idiopathic psoriatic alopecia mixed inflammatory response histologic examination hair regrowth TNFi therapy scarring alopecia TNFi psoriasis hair loss biopsy inflammation hair growth

TLDR Shrinking of oil glands in the skin is a key sign of hair loss linked to TNF inhibitor drugs and may improve if the treatment is stopped.

The study described the characteristics of TNF inhibitor associated psoriatic alopecia (TIAPA), with a focus on the atrophy of sebaceous lobules as a diagnostic feature. It involved three female patients, aged 43, 60, and 56, who developed scalp alopecia while on TNF inhibitor treatment for Crohn's disease and inflammatory arthritis, without prior history of psoriasis or alopecia. Scalp biopsies revealed that sebaceous lobule atrophy is a distinctive, potentially reversible feature of TIAPA, distinguishable from idiopathic psoriatic alopecia by drug exposure history and sometimes by a mixed inflammatory response in histologic examination. All patients experienced hair regrowth after discontinuing TNFi therapy, indicating that this atrophy does not lead to permanent scarring alopecia. The study concluded that sebaceous lobule atrophy is a key finding in TIAPA and may be reversible upon cessation of TNFi treatment.

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