Biologic-Induced Paradoxical Psoriatic Alopecia: A Systematic Review

A systemic review was completed of primary research articles reporting patient outcomes in paradoxical psoriatic alopecia in association with biologic therapy. Our search strategy identified 96 patients from 45 studies in addition to our own case. Our review indicates a higher prevalence of paradoxical psoriatic alopecia in younger female patients, most commonly secondary to TNF-alpha inhibitors. Unlike alopecia secondary to psoriasis vulgaris, a mixed inflammatory infiltrate featuring lymphocytes, plasma cells and eosinophils was observed. Remission was observed in most patients, including approximately a third of whom continued biologic therapy. Trial Registration: PROSPERO registration number: CRD42023471174.