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Anti–tumor necrosis factor (TNF) drugs are an important part of the therapeutic battery for the treatment of autoimmune disease, including psoriasis, inflammatory bowel disease, and rheumatoid arthritis. However, initiation of TNF inhibitor therapy in patients with no history of psoriasis can lead to the development of scaly plaques and alopecia. Investigators examined biopsy samples of lesions taken from three women (mean age, 29) who developed alopecia during anti–TNF-α treatment of Crohn disease.
The patients had large, scaly patches on the trunk and extremities along with the nonscarring alopecia on the head. Scalp samples revealed epidermal psoriasiform hyperplasia, hypogranulosis, and the presence of neutrophils. Follicular buds in the…