Certolizumab-Induced Paradoxical Psoriatic Alopecia

Introduction: Biologic drugs have revolutionized the treatment of chronic inflammatory immunologic diseases. However, their use is associated with adverse reactions, including paradoxical adverse events. Tumor necrosis factor (TNF)–associated psoriatic alopecia (TiAPA) is a paradoxical adverse event that has been rarely reported in the literature. Only 1 case secondary to certolizumab has been recently described. Case Presentation: We described a case of scalp alopecia secondary to certolizumab in a 27-year old female patient with Crohn disease. The skin biopsy showed psoriasiform changes and loss of sebaceous lobule compatible with TiAPA. The patient presented significant improvement in the clinical findings and hair regrowth after 4 weeks of treatment with clobetasol unguent 0.05% and discontinuation of certolizumab. Months later she received infliximab for her Crohn disease, achieving good control of the illness until today. Discussion: This is a paradoxical adverse event that has been rarely reported in the literature. Most of the cases were related with infliximab and adalimumab. There is no standard approach for the management of TNF inhibitor–induced psoriasis, but around 20% require discontinuation of treatment. Conclusions: The recognition of anti-TNF drug–induced alopecia has allowed description of a new form of alopecia, clinically and histologically mimicking primary psoriatic alopecia with the recently described finding of loss of sebaceous lobules. Recognizing this form of alopecia can enable effective treatment while allowing, in most cases, anti-TNF therapy to continue.