Successful management of a toddler with toxic epidermal necrolysis in a dermatology intensive care unit

psoriatic alopecia and alopecia areata. B en e et al. reported a statistically significant association between alopecia and some TNF-alpha antagonists, such as infliximab, adalimumab, and etanercept. In the same study, however, the association between alopecia and certolizumab was less consistent, due to the small number of reports. Indeed only three cases of psoriatic alopecia reaction secondary to certolizumab pegol have been reported in the literature. The mean latency between initiation of TNF-alpha antagonist therapy and the appearance of alopecia was 6 months. In one case, certolizumab was discontinued and replaced with ustekinumab, with complete hair regrowth after 16 weeks. The different immunological properties of various TNF-alpha monoclonal antibodies and the lack of the Fc fraction characterizing certolizumab may explain the lower incidence of paradoxical reactions with certolizumab compared to other anti-TNF. The pathophysiologic mechanism by which TNF-alpha antagonists induce alopecia in psoriatic patients is not yet well established. Certainly, further studies are needed to deepen the knowledge on biologic-induced psoriatic alopecia and possible treatment algorithm.