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
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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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 27 | 7 | 34 |
| 2024 Octubre | 190 | 42 | 232 |
| 2024 Septiembre | 205 | 31 | 236 |
| 2024 Agosto | 214 | 62 | 276 |
| 2024 Julio | 222 | 39 | 261 |
| 2024 Junio | 176 | 37 | 213 |
| 2024 Mayo | 182 | 47 | 229 |
| 2024 Abril | 164 | 34 | 198 |
| 2024 Marzo | 192 | 49 | 241 |
| 2024 Febrero | 175 | 46 | 221 |
| 2024 Enero | 184 | 36 | 220 |
| 2023 Diciembre | 166 | 26 | 192 |
| 2023 Noviembre | 170 | 46 | 216 |
| 2023 Octubre | 169 | 42 | 211 |
| 2023 Septiembre | 134 | 37 | 171 |
| 2023 Agosto | 122 | 28 | 150 |
| 2023 Julio | 145 | 40 | 185 |
| 2023 Junio | 120 | 36 | 156 |
| 2023 Mayo | 95 | 40 | 135 |
| 2023 Abril | 89 | 34 | 123 |
| 2023 Marzo | 60 | 33 | 93 |
| 2023 Febrero | 76 | 26 | 102 |
| 2023 Enero | 94 | 38 | 132 |
| 2022 Diciembre | 98 | 39 | 137 |
| 2022 Noviembre | 32 | 40 | 72 |
| 2022 Octubre | 44 | 19 | 63 |
| 2022 Septiembre | 39 | 25 | 64 |
| 2022 Agosto | 48 | 46 | 94 |
| 2022 Julio | 47 | 31 | 78 |
| 2022 Junio | 41 | 27 | 68 |
| 2022 Mayo | 101 | 42 | 143 |
| 2022 Abril | 167 | 45 | 212 |
| 2022 Marzo | 175 | 48 | 223 |
| 2022 Febrero | 102 | 40 | 142 |
| 2022 Enero | 120 | 48 | 168 |
| 2021 Diciembre | 139 | 52 | 191 |
| 2021 Noviembre | 144 | 43 | 187 |
| 2021 Octubre | 131 | 50 | 181 |
| 2021 Septiembre | 115 | 46 | 161 |
| 2021 Agosto | 109 | 44 | 153 |
| 2021 Julio | 89 | 33 | 122 |
| 2021 Junio | 107 | 45 | 152 |
| 2021 Mayo | 95 | 55 | 150 |
| 2021 Abril | 212 | 81 | 293 |
| 2021 Marzo | 134 | 41 | 175 |
| 2021 Febrero | 151 | 46 | 197 |
| 2021 Enero | 118 | 30 | 148 |
| 2020 Diciembre | 90 | 28 | 118 |
| 2020 Noviembre | 76 | 32 | 108 |
| 2020 Octubre | 74 | 17 | 91 |
| 2020 Septiembre | 64 | 18 | 82 |
| 2020 Agosto | 55 | 27 | 82 |
| 2020 Julio | 63 | 30 | 93 |
| 2020 Junio | 62 | 27 | 89 |
| 2020 Mayo | 37 | 38 | 75 |
| 2020 Abril | 47 | 26 | 73 |
| 2020 Marzo | 36 | 25 | 61 |
| 2020 Febrero | 4 | 6 | 10 |
| 2020 Enero | 6 | 12 | 18 |
| 2019 Diciembre | 8 | 5 | 13 |
| 2019 Noviembre | 3 | 8 | 11 |
| 2019 Octubre | 0 | 11 | 11 |
| 2019 Septiembre | 8 | 13 | 21 |
| 2019 Agosto | 5 | 9 | 14 |
| 2019 Julio | 4 | 15 | 19 |
| 2019 Junio | 4 | 10 | 14 |
| 2019 Mayo | 8 | 12 | 20 |
| 2019 Abril | 2 | 12 | 14 |
| 2019 Marzo | 2 | 17 | 19 |
| 2019 Febrero | 2 | 5 | 7 |
| 2019 Enero | 2 | 3 | 5 |
| 2018 Diciembre | 2 | 16 | 18 |
| 2018 Noviembre | 3 | 3 | 6 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 0 | 5 | 5 |
| 2018 Agosto | 0 | 15 | 15 |
| 2018 Julio | 0 | 23 | 23 |
| 2018 Junio | 0 | 4 | 4 |
| 2018 Mayo | 0 | 11 | 11 |
| 2018 Abril | 0 | 5 | 5 |
| 2018 Marzo | 1 | 7 | 8 |
| 2018 Febrero | 133 | 7 | 140 |
| 2018 Enero | 151 | 12 | 163 |
| 2017 Diciembre | 168 | 12 | 180 |
| 2017 Noviembre | 100 | 10 | 110 |
| 2017 Octubre | 59 | 17 | 76 |
| 2017 Septiembre | 78 | 16 | 94 |
| 2017 Agosto | 103 | 12 | 115 |
| 2017 Julio | 107 | 16 | 123 |
| 2017 Junio | 144 | 25 | 169 |
| 2017 Mayo | 130 | 16 | 146 |
| 2017 Abril | 140 | 24 | 164 |
| 2017 Marzo | 151 | 11 | 162 |
| 2017 Febrero | 86 | 17 | 103 |
| 2017 Enero | 81 | 20 | 101 |
| 2016 Diciembre | 118 | 18 | 136 |
| 2016 Noviembre | 156 | 16 | 172 |
| 2016 Octubre | 159 | 25 | 184 |
| 2016 Septiembre | 222 | 18 | 240 |
| 2016 Agosto | 141 | 15 | 156 |
| 2016 Julio | 97 | 14 | 111 |
| 2016 Junio | 20 | 15 | 35 |
| 2016 Mayo | 10 | 13 | 23 |
| 2016 Abril | 7 | 4 | 11 |
| 2016 Marzo | 12 | 4 | 16 |
| 2016 Febrero | 13 | 1 | 14 |
| 2016 Enero | 7 | 13 | 20 |
| 2015 Diciembre | 10 | 2 | 12 |
| 2015 Noviembre | 14 | 2 | 16 |
| 2015 Octubre | 15 | 1 | 16 |
| 2015 Septiembre | 8 | 4 | 12 |
| 2015 Agosto | 13 | 6 | 19 |
| 2015 Julio | 74 | 13 | 87 |
| 2015 Junio | 73 | 9 | 82 |
| 2015 Mayo | 120 | 19 | 139 |
| 2015 Abril | 98 | 15 | 113 |
| 2015 Marzo | 64 | 20 | 84 |
| 2015 Febrero | 80 | 18 | 98 |
| 2015 Enero | 75 | 15 | 90 |
| 2014 Diciembre | 81 | 12 | 93 |
| 2014 Noviembre | 73 | 19 | 92 |
| 2014 Octubre | 73 | 18 | 91 |
| 2014 Septiembre | 62 | 12 | 74 |
| 2014 Agosto | 57 | 21 | 78 |
| 2014 Julio | 69 | 21 | 90 |
| 2014 Junio | 96 | 18 | 114 |
| 2014 Mayo | 101 | 28 | 129 |
| 2014 Abril | 68 | 17 | 85 |
| 2014 Marzo | 89 | 23 | 112 |
| 2014 Febrero | 77 | 17 | 94 |
| 2014 Enero | 54 | 20 | 74 |
| 2013 Diciembre | 64 | 14 | 78 |
| 2013 Noviembre | 22 | 14 | 36 |
| 2013 Octubre | 10 | 14 | 24 |
| 2013 Septiembre | 13 | 8 | 21 |
| 2013 Agosto | 18 | 71 | 89 |
| 2013 Julio | 6 | 15 | 21 |
| 2013 Junio | 12 | 26 | 38 |
| 2013 Mayo | 18 | 17 | 35 |
| 2013 Abril | 11 | 17 | 28 |
| 2013 Marzo | 26 | 15 | 41 |
| 2013 Febrero | 39 | 5 | 44 |
| 2013 Enero | 23 | 4 | 27 |
| 2012 Diciembre | 22 | 7 | 29 |
| 2012 Noviembre | 0 | 1 | 1 |
| 2012 Octubre | 1 | 2 | 3 |
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