Hair Loss Induced by Tumor Necrosis Factor Alpha Inhibitors

Background: Alopecia is a possible adverse reaction to Tumor Necrosis Factor alpha (TNF-α) inhibitors. This side effect has become more recognized in recent years through FDA postmarketing surveillance and it description in case reports/case series. Objective: We review the literature and summarize the pathogenesis, clinical presentation, prognosis, and management strategies for TNF-α inhibitor induced alopecia. Methods: We performed a Medline search from January 1998 until August 2013 to identify all cases of alopecia during anti-TNF-α therapy described in the literature. We also reviewed FDA postmarketing data and clinical trials. Results: There were 62 cases of hair loss occurring during therapy with TNF-α inhibitors that we identified during our literature search. The causes of hair loss included alopecia areata, psoriatic alopecia, lichen planopilaris, drug-induced lupus erythematosus, androgenetic alopecia, and telogen effluvium. Alopecia was also a mentioned side effect in three clinical trials and in FDA postmarketing surveillance. Limitations: There are few controlled trials directly studying TNF-α inhibitor induced alopecia and most of our understanding of this clinical condition comes from anecdotal experience. Conclusions: TNF-α inhibitors can cause different types of hair loss including severe alopecia areata and scarring alopecia.