Abstract
Alopecia universalis is an advanced form of alopecia areata, characterized by complete loss of hair on all hair-bearing areas. It is currently believed to be an autoimmune disorder. The development of alopecia during treatment with tumor necrosis factor alpha (TNF-α) inhibitors is a rarely observed adverse event. This case describes a 56-year-old female patient with rheumatoid arthritis (RA), who developed alopecia universalis during treatment with adalimumab. There was no improvement in alopecia despite withdrawal of adalimumab. It is believed that interferon-α is the main cytokine involved in promoting inflammation in hair loss after blocking TNF-α by TNF inhibitors. Risk/benefit ratio of maintenance and discontinuation of the drug should be weighed up when alopecia appears during treatment with TNF inhibitors.
Zusammenfassung
Alopecia universalis ist eine fortgeschrittene Form der Alopecia areata, die durch vollständigen Haarverlust in allen behaarten Regionen gekennzeichnet ist. Derzeit wird sie als Autoimmunerkrankung eingestuft. Die Entstehung einer Alopezie während der Behandlung mit Inhibitoren von Tumornekrosefaktor-alpha (TNF-α) ist eine selten beobachtete Nebenwirkung. Der hier vorgestellte Fall handelt von einer 56-jährigen Patientin mit rheumatoider Arthritis (RA), bei der eine Alopecia universalis unter Therapie mit Adalimumab auftrat. Trotz des Absetzens von Adalimumab kam es nicht zur Besserung der Alopezie. Man geht davon aus, dass Interferon-α das wesentliche Zytokin darstellt, das fördernd am Entzündungsprozess bei Haarverlust nach Blockade von TNF-α durch TNF-Inhibitoren beteiligt ist. Das Risiko-Nutzen-Verhältnis zwischen Fortsetzung und Absetzen dieses Präparats sollte abgewogen werden, wenn es unter Therapie mit TNF-Inhibitoren zur Alopezie kommt.
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P. Ostojic and S. Pavlov-Dolijanovic declare that they have no competing interests.
This article does not contain any studies with human participants or animals performed by any of the authors. Consent was obtained from all patients identifiable from images or other information within the manuscript. In the case of underage patients, consent was obtained from a parent or legal guardian.
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Ostojic, P., Pavlov-Dolijanovic, S. Alopecia universalis in a patient with rheumatoid arthritis developed during treatment with adalimumab. Z Rheumatol 77, 412–415 (2018). https://doi.org/10.1007/s00393-018-0464-z
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DOI: https://doi.org/10.1007/s00393-018-0464-z