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Paradoxical psoriatic alopecia and lack of efficacy: case report A 27-year-old woman developed paradoxical psoriatic alopecia during treatment with certolizumab-pegol for Crohn’s disease. She also exhibited lack of efficacy while receiving adalimumab for Crohn’s disease. The woman had a history of Crohn’s disease. During the past 5 years, she received infliximab and adalimumab. But due to lack of response to adalimumab, she started receiving SC certolizumab-pegol [certolizumab] 400mg every 4 weeks. However, six months after the therapy, she developed multiple desquamative and erythematous alopecia plaques on the scalp. Trichoscopy demonstrated structureless red areas, thick and yellowish scales and follicular pustules. In the areas, without plaques, a white seborrheic and subtle scale in the interfollicular area was noted. These plaques were also noted on the back of the neck, as well as in the retroauricular region. Her medical history and family history was unremarkable for psoriasis. Under the assumption of tumour necrosis factor (TNF)-associated psoriatic alopecia (TiAPA), pemphigus foliaceus, discoid lupus, cutaneous Crohn infiltration or bacterial infection, she underwent two skin biopsies. Histopathology specimen demonstrated regular acanthosis in the epidermis, hypogranulosis, hyperparakeratosis and neutrophils in the stratum corneum and a dense plasma cell infiltrate in the dermis. It also demonstrated mature hair follicles with loss of sebaceous lobule consistent with psoriatic alopecia. The periodic acid-Schiff stain was negative. Based on these findings, she was diagnosed with certolizumab-pegol-associated paradoxical psoriatic alopecia. Therefore, the woman discontinued certolizumab and received topical treatment with clobetasol and coal tar shampoo. After 4 weeks of treatment, she had significant improvement with hair regrowth. Thereafter, she reinitiated infliximab for Crohn disease. At the time of this report, her Crohn’s disease was in good control. Ferraresso MG, et al. Certolizumab-Induced Paradoxical Psoriatic Alopecia. Journal of Psoriasis and Psoriatic Arthritis 5: 86-92, No. 3, Jul 2020. Available from: URL: http:// 803507111 doi.org/10.1177/2475530320928625

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Reactions 17 Oct 2020 No. 1826