Case and research letters
Alopecia Areata After Biologic Therapy: Report of a Case Related to Adalimumab
Alopecia areata y terapias biológicas. Presentación de un caso asociado a adalimumab
J. Neila
, A. Carrizosa, C. Ceballos, F.M. Camacho
Corresponding author
Departamento de Dermatología Médico Quirúrgica, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Neila, A. Carrizosa, C. Ceballos, F.M. Camacho" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Neila" "email" => array:1 [ 0 => "drneils@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Carrizosa" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Ceballos" ] 3 => array:2 [ "nombre" => "F.M." "apellidos" => "Camacho" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Departamento de Dermatología Médico Quirúrgica, Hospital Universitario Virgen Macarena, Sevilla, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Alopecia areata y terapias biológicas. Presentación de un caso asociado a adalimumab" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1173 "Ancho" => 1583 "Tamanyo" => 238113 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Alopecia areata plaque located on the cranial vertex after a year of adalimumab treatment.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Alopecia areata (AA) is an autoimmune disorder causing nonscarring hair loss. It is an organ-specific response at the cellular level and is mediated by CD4<span class="elsevierStyleSup">+</span> and CD8<span class="elsevierStyleSup">+</span> T cells. These lymphocytes may be activated by autoantigens at the hair root, inducing inflammation that eventually leads to hair loss. The increased use of biologic therapies has recently led to a growing number of publications discussing the possible link between these treatments and autoimmune disorders, including AA.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 39-year-old man with plaque psoriasis on a regimen of adalimumab (40<span class="elsevierStyleHsp" style=""></span>mg) twice weekly presented with 2 alopecia plaques after 1 year of treatment. The plaques, located on the cranial vertex, had appeared over the previous few weeks (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient had no family or personal history of AA and reported no events involving infection, vaccination, or stress prior to the loss of hair. AA was diagnosed, adalimumab treatment was stopped, and a daily application of clobetasol propionate 0.05% cream was prescribed. After 6 months the diameter of both alopecia plaques had not changed despite the withdrawal of adalimumab.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Adalimumab is a recombinant and fully humanized monoclonal antibody that works against tumor necrosis factor α (TNF-α) and has been approved for the treatment of rheumatoid arthritis, ankylosing spondylitis, Crohn disease, psoriasis, and psoriatic arthritis. TNF-α is a proinflammatory cytokine in the body's immune system, but when it is neutralized by anti-TNF-α antibodies like adalimumab, autoimmune disorders such as systematic sclerosis and systemic lupus erythematosus have been known to develop.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The role of TNF-α in the physiopathology of these processes is complex, but the cytokine has been shown to originate in the mononuclear cells that surround the hair follicle in AA<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and inhibit hair follicle growth during in vitro testing.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> TNF-α is thus linked to hair loss. Accordingly, anti-TNF-α medications and other biologic therapies have been used to treat AA, but with poor results; in some sporadic cases satisfactory responses have been reported, but no large study has demonstrated any significant therapeutic effects of etanercept,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> alefacept,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> or efalizumab.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">At the same time, new cases of AA have become more frequent in patients undergoing treatment with anti-TNF-α and other biologic therapies. Cases of AA induced by etanercept, infliximab, and adalimumab are being reported. García Bartels et al<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> were the first to describe adalimumab-induced AA; the patient was a 23-year-old woman who developed AA universalis 2 months after starting treatment. Seven patients have since been described; only 2 had a past history of AA and 3 developed the universalis form.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,6–10</span></a> The amount of time from starting treatment with anti-TNF-α to the appearance of AA ranged between 2 months and 2 years. In cases in which adalimumab was withdrawn, no new hair growth occurred in any of the patients studied. Similarly, hair did not regrow on our patient's plaques.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The mechanism by which TNF-α inhibition induces AA is unknown. In 2005, De Bandt et al<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> hypothesized, on the basis of 22 cases of anti-TNF-α-induced systemic lupus erythematosus in France, that TNF-α initiates the spread of suppressed CD4<span class="elsevierStyleSup">+</span> regulatory T lymphocytes that are responsible for maintaining immunological tolerance and preventing autoimmunity. Thus, both AA and other autoimmune processes induced by anti-TNF-α may develop through the inhibition of regulatory T cells. However, whereas all patients with lupus went into remission after the withdrawal of anti-TNF-α, patients with AA do not usually respond.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In this new case of AA associated with adalimumab treatment, the possibility of coincidence cannot be ruled out; however, earlier reports of AA in patients treated with adalimumab and the implication of anti-TNF-α medications in inducing other autoimmune disorders suggests an association between hair loss and the use of this TNF inhibitor.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Neila J, et al. Alopecia areata y terapias biológicas. Presentación de un caso asociado a adalimumab. Actas Dermosifiliograf.2011;102:827-828.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1173 "Ancho" => 1583 "Tamanyo" => 238113 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Alopecia areata plaque located on the cranial vertex after a year of adalimumab treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alopecia areata universalis elicited during treatment with adalimumab" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 26 | 7 | 33 |
| 2024 October | 190 | 42 | 232 |
| 2024 September | 205 | 31 | 236 |
| 2024 August | 214 | 62 | 276 |
| 2024 July | 222 | 39 | 261 |
| 2024 June | 176 | 37 | 213 |
| 2024 May | 182 | 47 | 229 |
| 2024 April | 164 | 34 | 198 |
| 2024 March | 192 | 49 | 241 |
| 2024 February | 175 | 46 | 221 |
| 2024 January | 184 | 36 | 220 |
| 2023 December | 166 | 26 | 192 |
| 2023 November | 170 | 46 | 216 |
| 2023 October | 169 | 42 | 211 |
| 2023 September | 134 | 37 | 171 |
| 2023 August | 122 | 28 | 150 |
| 2023 July | 145 | 40 | 185 |
| 2023 June | 120 | 36 | 156 |
| 2023 May | 95 | 40 | 135 |
| 2023 April | 89 | 34 | 123 |
| 2023 March | 60 | 33 | 93 |
| 2023 February | 76 | 26 | 102 |
| 2023 January | 94 | 38 | 132 |
| 2022 December | 98 | 39 | 137 |
| 2022 November | 32 | 40 | 72 |
| 2022 October | 44 | 19 | 63 |
| 2022 September | 39 | 25 | 64 |
| 2022 August | 48 | 46 | 94 |
| 2022 July | 47 | 31 | 78 |
| 2022 June | 41 | 27 | 68 |
| 2022 May | 101 | 42 | 143 |
| 2022 April | 167 | 45 | 212 |
| 2022 March | 175 | 48 | 223 |
| 2022 February | 102 | 40 | 142 |
| 2022 January | 120 | 48 | 168 |
| 2021 December | 139 | 52 | 191 |
| 2021 November | 144 | 43 | 187 |
| 2021 October | 131 | 50 | 181 |
| 2021 September | 115 | 46 | 161 |
| 2021 August | 109 | 44 | 153 |
| 2021 July | 89 | 33 | 122 |
| 2021 June | 107 | 45 | 152 |
| 2021 May | 95 | 55 | 150 |
| 2021 April | 212 | 81 | 293 |
| 2021 March | 134 | 41 | 175 |
| 2021 February | 151 | 46 | 197 |
| 2021 January | 118 | 30 | 148 |
| 2020 December | 90 | 28 | 118 |
| 2020 November | 76 | 32 | 108 |
| 2020 October | 74 | 17 | 91 |
| 2020 September | 64 | 18 | 82 |
| 2020 August | 55 | 27 | 82 |
| 2020 July | 63 | 30 | 93 |
| 2020 June | 62 | 27 | 89 |
| 2020 May | 37 | 38 | 75 |
| 2020 April | 47 | 26 | 73 |
| 2020 March | 36 | 25 | 61 |
| 2020 February | 4 | 6 | 10 |
| 2020 January | 6 | 12 | 18 |
| 2019 December | 8 | 5 | 13 |
| 2019 November | 3 | 8 | 11 |
| 2019 October | 0 | 11 | 11 |
| 2019 September | 8 | 13 | 21 |
| 2019 August | 5 | 9 | 14 |
| 2019 July | 4 | 15 | 19 |
| 2019 June | 4 | 10 | 14 |
| 2019 May | 8 | 12 | 20 |
| 2019 April | 2 | 12 | 14 |
| 2019 March | 2 | 17 | 19 |
| 2019 February | 2 | 5 | 7 |
| 2019 January | 2 | 3 | 5 |
| 2018 December | 2 | 16 | 18 |
| 2018 November | 3 | 3 | 6 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 0 | 5 | 5 |
| 2018 August | 0 | 15 | 15 |
| 2018 July | 0 | 23 | 23 |
| 2018 June | 0 | 4 | 4 |
| 2018 May | 0 | 11 | 11 |
| 2018 April | 0 | 5 | 5 |
| 2018 March | 1 | 7 | 8 |
| 2018 February | 133 | 7 | 140 |
| 2018 January | 151 | 12 | 163 |
| 2017 December | 168 | 12 | 180 |
| 2017 November | 100 | 10 | 110 |
| 2017 October | 59 | 17 | 76 |
| 2017 September | 78 | 16 | 94 |
| 2017 August | 103 | 12 | 115 |
| 2017 July | 107 | 16 | 123 |
| 2017 June | 144 | 25 | 169 |
| 2017 May | 130 | 16 | 146 |
| 2017 April | 140 | 24 | 164 |
| 2017 March | 151 | 11 | 162 |
| 2017 February | 86 | 17 | 103 |
| 2017 January | 81 | 20 | 101 |
| 2016 December | 118 | 18 | 136 |
| 2016 November | 156 | 16 | 172 |
| 2016 October | 159 | 25 | 184 |
| 2016 September | 222 | 18 | 240 |
| 2016 August | 141 | 15 | 156 |
| 2016 July | 97 | 14 | 111 |
| 2016 June | 20 | 15 | 35 |
| 2016 May | 10 | 13 | 23 |
| 2016 April | 7 | 4 | 11 |
| 2016 March | 12 | 4 | 16 |
| 2016 February | 13 | 1 | 14 |
| 2016 January | 7 | 13 | 20 |
| 2015 December | 10 | 2 | 12 |
| 2015 November | 14 | 2 | 16 |
| 2015 October | 15 | 1 | 16 |
| 2015 September | 8 | 4 | 12 |
| 2015 August | 13 | 6 | 19 |
| 2015 July | 74 | 13 | 87 |
| 2015 June | 73 | 9 | 82 |
| 2015 May | 120 | 19 | 139 |
| 2015 April | 98 | 15 | 113 |
| 2015 March | 64 | 20 | 84 |
| 2015 February | 80 | 18 | 98 |
| 2015 January | 75 | 15 | 90 |
| 2014 December | 81 | 12 | 93 |
| 2014 November | 73 | 19 | 92 |
| 2014 October | 73 | 18 | 91 |
| 2014 September | 62 | 12 | 74 |
| 2014 August | 57 | 21 | 78 |
| 2014 July | 69 | 21 | 90 |
| 2014 June | 96 | 18 | 114 |
| 2014 May | 101 | 28 | 129 |
| 2014 April | 68 | 17 | 85 |
| 2014 March | 89 | 23 | 112 |
| 2014 February | 77 | 17 | 94 |
| 2014 January | 54 | 20 | 74 |
| 2013 December | 64 | 14 | 78 |
| 2013 November | 22 | 14 | 36 |
| 2013 October | 10 | 14 | 24 |
| 2013 September | 13 | 8 | 21 |
| 2013 August | 18 | 71 | 89 |
| 2013 July | 6 | 15 | 21 |
| 2013 June | 12 | 26 | 38 |
| 2013 May | 18 | 17 | 35 |
| 2013 April | 11 | 17 | 28 |
| 2013 March | 26 | 15 | 41 |
| 2013 February | 39 | 5 | 44 |
| 2013 January | 23 | 4 | 27 |
| 2012 December | 22 | 7 | 29 |
| 2012 November | 0 | 1 | 1 |
| 2012 October | 1 | 2 | 3 |
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