TNF Inhibitor Induced Alopecia: An Unusual Form of Psoriasiform Alopecia That Breaks the Renbök Mold
January 2017
in “
Dermatology Online Journal
”
TNF-α inhibitors psoriasiform alopecia psoriasis alopecia areata catagen hairs telogen hairs psoriasiform epidermal hyperplasia perifollicular lymphocytic infiltrate eosinophils plasma cells ustekinumab topical immunosuppressants intralesional immunosuppressants systemic immunosuppressants TNF-alpha inhibitors
TLDR Some hair loss drugs can cause a unique type of hair loss that resembles both psoriasis and alopecia.
The document from 2017 discusses a unique pattern of hair loss induced by TNF-α inhibitors, which are known to cause skin adverse effects including psoriasis and alopecia areata. The hair loss pattern described has features similar to both psoriasis and alopecia areata. Diagnosis of this condition requires clinical-pathologic correlation and is supported by increased catagen/telogen hairs, psoriasiform epidermal hyperplasia, perifollicular lymphocytic infiltrate, and the presence of eosinophils and plasma cells. There were no treatment consensus guidelines at the time, but management options included stopping therapy, switching to a different TNF-α inhibitor or ustekinumab (in severe cases), or continuing TNF-α inhibitor therapy with the addition of topical, intralesional, or systemic immunosuppressants. The study was based on a case of a 21-year-old female with Crohn’s disease who presented with subacute worsening of chronic, erythematous, scaly plaques on the scalp and ears, with new areas of hair loss developing over 2 months.
