The drug causes psoriatic hair loss in a patient with Crohn’s disease in Puerto Rico

The case is relevant because specialists emphasize an individual approach that provides patients with the safest treatment option.

The patient before and after the diagnosis of psoriatic alopecia. Photo: Case report, National Library of Medicine.

Although science has confirmed this, each patient can react differently.

And in Puerto Rico, the scientific literature reported a case of an adverse drug reaction in a pediatric patient.

The case of a child under 12 years of age was a Crohn’s patient treated with adalimumab who developed a hard, scaly plaque on the scalp after 6 months of increasing the dose of the drug.

“The girl came to our consultation Dermatological diseases with erythematous scaly plaques In the trunk, scalp, arms and legs for two months of development. The lesions affected about 15% of the body’s surface,” noted the authors of the case associated with the Pool of Medical Sciences.

The most prominent medical history of the patient suffering from the disease Crohn’s, who was diagnosed 4 years ago Show skin lesions. Alopecia areata is a type of scalp alopecia, in which white scales form at the base of the scalp. Hair with some sneak And infections that can affect the hair follicles. In this way it can damage it and stimulate the aforementioned hair loss.

Photo: a. The first scalp biopsy showed a dense infiltration of neutrophils in the dermis and perifollicular area (H&E, original magnification × 200). B, Second scalp biopsy showed a collection of neutrophils within the cornea at high magnification (H&E, original magnification × 400). C and D, psoriatic hyperplasia with mild enlargement and absence of granulomatous layer on second biopsy (H&E, original magnifications ×100 and ×200).

“The patient had been treated for the past two years with adalimumab 40 mg once weekly and azathioprine 100 mg once daily. Due to poor control of Crohn’s disease, the dose of adalimumab was increased to 40 mg once weekly, 6 Months before the current presentationThey explained.

Researchers from the University of Puerto Rico School of Medicine, San Juan, noted that this family of drugs can cause various side effects, some as common as injection site reactions and others as rare as Paradoxical induction of pests psoriasis skin;

At this opportunity, tumor necrosis factor-a (TNF-a) inhibitors are used to treat many inflammatory diseases, such as rheumatoid arthritis, the disease Inflammatory bowel disease and psoriasis, among others, but in this young woman caused a reaction recorded only 26 times in the medical literature.

“Our diagnosis was of psoriasis caused by TNF-a inhibitors secondary to adalimumab treatment,” they reveal in a paper published in the National Library of Medicine.

To reverse the effect, the patient was treated with 0.1% mometasone solution for scalp lesions and 0.1% triamcinolone cream for body injuries. Given how common the psoriasis is, we recommend switching from adalimumab to ustekinumab, which is approved for Crohn’s disease in adults but is not mentioned on the children’s label.

“At one month follow-up, after receiving an induction dose of ustinumab, the patient showed partial improvement in the skin lesions, but developed large, solid erythematous plaques with thick, yellowish scales on the scalp. She also had a positive hair-pulling test. The default initial diagnosis was a balding lesion. In the scalp is tinea capitis, where multiple preparations of lignans containing potassium hydroxide were made, and all were negative,” they explain.

For this reason, they recommend an individualized approach that provides patients with the safest and least invasive treatment option for TNF-α inhibitor-induced alopecia areata.

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