Paradoxical Psoriasis and Alopecia Areata After the Use of Anti-TNF in a Patient With Crohn's Disease

This case report discusses a 20-year-old male patient with Crohn's disease who developed paradoxical psoriasis and alopecia areata after being treated with the anti-TNF therapy infliximab. Despite initial improvement in Crohn's symptoms, the patient experienced hair loss and psoriasiform changes on the scalp and ears, which were confirmed by biopsy to be psoriatic alopecia and alopecia areata. Treatments with Triamcinolone, clobetasol, and calcipotriene were ineffective, but switching to Ustekinumab improved both his hair loss and Crohn's symptoms. The report highlights the complexity of autoimmune responses to anti-TNF therapy and emphasizes the importance of a multidisciplinary approach in managing such cases. A meta-analysis cited in the discussion found that out of 134 patients who developed alopecia with IBD therapy, 78 were on anti-TNF-α therapy, with psoriatic alopecia being the most common.