Alopecia areata as another immune-mediated disease developed in patients treated with tumour necrosis factor-α blocker agents

Background Tumour necrosis factor antagonists (anti-TNF-alpha) have demonstrated the efficacy in different chronic immune inflammatory disorders. Within the spectrum of adverse events, autoimmune diseases have been observed, including cases of alopecia areata (AA). Objectives The objective of the study is to characterize AA developed during anti-TNF-alpha therapy. Methods We present five new cases and review all the cases reported in the literature (eleven). Results One third of the cases had a positive (personal or family) history of AA. Most of them presented with rapid extensive AA, usually involving the ophiasis area. Prognosis was usually poor, with slight response to treatments. In the cases where anti-TNF-alpha therapy was maintained, the course did not seem to change. Conclusions Although rare, AA developed during anti-TNF-alpha therapy might be more frequent than suggested by reports of isolated cases. Personal and family history of autoimmune disease might alert clinicians to their possible development or relapse once the anti-TNF-alpha therapy is started.