Melé-Ninot Gemma, Expósito-Serrano Vicente, Quintana Codina Mònica, Iglesias Sancho Maribel, Sánchez-Regaña Manuel, Umbert Millet Pablo, Salleras Redonnet Montse
Department of Dermatology, Hospital Universitari Sagrat Cor, Barcelona, Spain.
Dermatol Online J. 2017 Jul 15;23(7):13030/qt3vm9z8qm.
Alopecia induced by biological therapy is a rare side effect of this type of drugs. A total of 23 patients of psoriasiform eruptions with severe scalp involvement that induced alopecia during anti-tumor necrosis factor (anti-TNF) treatment of non-dermatological conditions have been previously reported. We present a 50-year-old man affected by plaque psoriasis that developed psoriasiform patches with alopecia over his scalp 10 months after initiating treatment with adalimumab. Punch biopsy of the alopecic area on the scalp revealed psoriasiform epidermal changes and alopecia areata-like dermal changes. Along with these findings, there was a dermal inflammatory infiltrate made up of eosinophils and plasma cells. In conclusion, scalp psoriasiform lesions with alopecia in patients treated with anti-TNF agents have been rarely reported. We describe a patient with anti-TNF therapy-related alopecia affected by psoriasis. Our patient has a peculiar histology with features of psoriasis and alopecia areata in addition to eosinophils and plasma cells. This entity may respond to topical treatment. However in patients of severe scalp involvement anti-TNF suspension should be considered.
生物疗法诱发的脱发是这类药物罕见的副作用。先前已有报道，共有23例患有银屑病样皮疹且头皮严重受累的患者，在非皮肤病的抗肿瘤坏死因子（抗TNF）治疗期间出现了脱发。我们报告1例50岁斑块状银屑病男性患者，在使用阿达木单抗治疗10个月后，头皮出现伴有脱发的银屑病样斑块。对头皮脱发区进行打孔活检，结果显示为银屑病样表皮改变及斑秃样真皮改变。除此之外，还有由嗜酸性粒细胞和浆细胞组成的真皮炎症浸润。总之，抗TNF药物治疗的患者出现伴有脱发的头皮银屑病样病变的情况鲜有报道。我们描述了1例患有银屑病且出现抗TNF治疗相关脱发的患者。我们的患者具有独特的组织学特征，除了嗜酸性粒细胞和浆细胞外，还有银屑病和斑秃的特征。该病症可能对局部治疗有反应。然而，对于头皮严重受累的患者，应考虑停用抗TNF药物。
