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In this case report, a patient with Crohn's disease experienced alopecia and psoriasiform reactions attributed to anti-TNF therapy, which improved after switching to Ustekinumab.

This case report describes a young woman with ankylosing spondylitis who developed a severe paradoxical skin reaction after six months on certolizumab, requiring treatment with secukinumab and methotrexate.

This study systematically reviewed literature on paradoxical reactions during biologic treatments for psoriasis, identifying immune dysregulation mechanisms and diverse clinical manifestations, highlighting that mild cases often respond well to topical treatments, while severe cases may require switching to different IL-23 inhibitors.

This study found that among anti-TNF-α agents, certolizumab is the least likely to cause paradoxical reactions such as psoriatic alopecia and appears to be an effective and safe option for managing psoriasis and PsA while minimizing these risks.

This study found that in patch- and plaque-stage scalp psoriasis, sebaceous gland atrophy and reduced hair follicle size were common but there was no evidence of alopecia.