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In recent years, with the increase usage of tumour necrosis factor (TNF) inhibitors, more side effects have revealed. The incidence of paradoxical psoriasis (psoriasis vulgaris, palmoplantar pustulosis, scalp psoriasis or their combinations) ranges from 1 to 5%; however alopecia due to anti-TNF- α-induced scalp psoriasis, rarely reported in the literature. We report a 37-year-old woman who developed palmoplantar pustulosis and scalp psoriasis with severe alopeciaafter 2 months of treatment with adalimumab for chronic plaque psoriasis. Biopsies from the palmar and scalp lesions showed psoriasiform changes. Adalimumab treatment was discontinued, and methotrexate wasstarted (15 mg/weekly, subcutaneously) with topical adjuvant agents. A dramatic improvement was seen in both the skin and scalp with complete hair regrowth in one month. We conclude that, in anti-TNF-α-induced scalp psoriasis, suspension of anti-TNF- α agent and systemic and topical treatments should be considered in order to avoid scarring alopecia. This article is protected by copyright. All rights reserved.
This article was published in the following journal.
Name: Dermatologic therapy
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A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis.
A microscopically inflammatory, usually reversible, patchy hair loss occurring in sharply defined areas and usually involving the beard or scalp. (Dorland, 27th ed)
Skin diseases involving the SCALP.
A group of tetraterpenes, with four terpene units joined head-to-tail. Biologically active members of this class are used clinically in the treatment of severe cystic ACNE; PSORIASIS; and other disorders of keratinization.
White or pink lesions on the arms, hands, face, or scalp that arise from sun-induced DNA DAMAGE to KERATINOCYTES in exposed areas. They are considered precursor lesions to superficial SQUAMOUS CELL CARCINOMA.
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Cytokine Tumour Necrosis Factor (TNF)
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