Alopecia Areata Following Adalimumab

Background. Alopecia areata is a nonscarring hair loss characterized by well-circumscribed patchy areas, most often on the scalp. The inflammatory cytokine tumor necrosis factor alpha (TNF-alpha), has been connected with the development of alopecia areata in vivo; thus, the TNF-alpha inhibitors have been cited as possible treatments for this autoimmune condition. Objective: We report a case of alopecia areata that developed in a 52-year-old woman who was recently started on adalimumab for treatment of her psoriatic arthritis. Results: We discuss the previously published cases in the literature linking alopecia areata to TNF-alpha inhibitor administration. Our case is the first report of a new-onset alopecia areata following adalimumab. Conclusions: Even though TNF-alpha is implicated in causing alopecia areata, TNF-alpha inhibitors have paradoxically been associated with new cases of alopecia areata. It is possible that TNF-alpha may not be involved in the pathogenesis of alopecia areata, as in vitro studies have suggested.