Adalimumab-Induced Psoriasis with Severe Alopecia

Area of Science:

• Dermatology
• Immunology
• Gastroenterology

Background:

• Crohn's disease is a chronic inflammatory condition often treated with biologic therapies.
• Adalimumab, a TNF-alpha inhibitor, is a common treatment for Crohn's disease and associated arthritis.
• Adverse dermatological reactions can occur with biologic therapies, necessitating careful monitoring.

Observation:

• A 52-year-old female smoker with Crohn's disease developed severe alopecia and pustular lesions on palms, soles, and scalp after 2 months of adalimumab treatment.
• The patient had no prior history of psoriasis.
• Skin biopsy was performed, and adalimumab was discontinued.

Findings:

• Treatment was switched to ustekinumab (anti-IL12/23), a biologic targeting different inflammatory pathways.
• Two months after initiating ustekinumab, the patient presented with alopecia, suggesting a potential side effect of the previous adalimumab therapy.
• The pustular lesions resolved following the switch in medication.

Implications:

• This case highlights a potential association between adalimumab and the development of alopecia and pustular dermatoses.
• Ustekinumab may be a viable alternative for patients experiencing such adverse effects from adalimumab.
• Further research is warranted to elucidate the mechanisms behind these drug-induced dermatological conditions.