Abstract:

<pTumor necrosis factor-alpha (TNF-?) inhibitors have important clinical use for chronic inflammatory and immune-mediated conditions including psoriasis, Crohn’s disease (CD), and hidradenitis suppurativa (HS). The increased usage of TNF-? inhibitors over recent years has led to the discovery of new side effects, including rare adverse cutaneous reactions such as paradoxical psoriasis. We present a patient with long-standing CD and HS who was treated with adalimumab, and subsequently developed psoriatic alopecia. The patient presented with a two-month history of hair loss associated with scalp pruritus and pain, approximately after 2 years of starting therapy. Clinical examination revealed a boggy, edematous scalp with erythema and scale, as well as a 13 x 8 cm patch of reduced hair density. A punch biopsy from the vertex scalp revealed compact parakeratosis with neutrophils. The epidermis showed psoriasiform hyperplasia with focal but prominent neutrophilic exocytosis and loss of the granular layer. The dermis showed mixed inflammatory infiltrate with underlying scarring, hair loss, and atrophy of sebaceous glands. Adalimumab was discontinued and ustekinumab was initiated for HS and CD control. Significant hair regrowth and improvement of erythema was observed within 2 months. TNF-? inhibitor associated paradoxical psoriatic alopecia is a rare entity that has been recently described in the literature. Histopathologic evaluation is necessary in making the diagnosis, and prompt recognition and treatment of the condition is important in preventing the development of a potentially irreversible, scarring alopecia.

Financial Disclosure:
No current or relevant financial relationships exist.

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Nikki Rezania, BA

Biography