Severe plaque psoriasis with coexisting cicatricial alopecia treated with adalimumab – case report

Introduction. Tumor necrosis factor α (TNF-α) inhibitors are used in the management of many immune-mediated diseases, including the treatment of severe plaque psoriasis. Lichen planopilaris is an inflammatory dermatosis, which typically affects women at the perimenopausal age and is a cause of progressive cicatricial alopecia. It is stated that TNF-α plays an important role in the pathogenesis of both psoriasis and lichen planopilaris, in which it is responsible for apoptosis of basement layer keratinocytes. There are few reports in the literature concerning lichen planopilaris observed during treatment of psoriasis and psoriatic arthritis with TNF-α antagonists.

Objective. To present and discuss the case of a patient with severe plaque psoriasis with coexisting scarring alopecia treated with adalimumab.

Case report. A 54-year-old female patient with a few-year history of hair loss was treated with adalimumab for severe plaque psoriasis. During biologic therapy almost complete remission of psoriatic lesions was observed, but in the scalp area diffuse scarring alopecia with hyperkeratotic perifollicular papules was seen, with no features of inflammation. On the basis of clinical appearance and histopathological examination a diagnosis of lichen planopilaris was established. A topical treatment was applied with good results.

Conclusions. In the presented case the therapy with TNF-α antagonist was effective in the treatment of psoriasis. Probably, it also inhibited active lesions of lichen planopilaris.