Tumor necrosis factor α inhibitor-induced alopecia in pediatric patients: a cohort of 20 patients and review of the literature.

Anti TNFα agents can induce cutaneous adverse events in both adults and children. While drug-related alopecia was reported in adults treated with TNFα inhibitors for various indications, pediatric data are scarce. To describe clinical characteristics and outcomes in pediatric patients with TNFα inhibitor-induced alopecia we conducted a single center retrospective study (0748-21-RMC, retrospectively registered on January 2nd 2022) including all patients aged < 18 years who were treated with TNFα inhibitors for any indication and developed drug-induced alopecia between the years 2018-2023. A comprehensive literature review was also performed. Twenty patients were included (mean age 12.9 ± 3.1 years, male:female ratio 1:1.4). Fourteen were diagnosed with Crohn's disease, three with ulcerative colitis, and three with juvenile idiopathic arthritis. Half of the patients were treated with adalimumab and half with infliximab. Overall, alopecia was observed after 14.8 ± 10.8 months of treatment. Eighteen (90.0%) patients presented with psoriatic-like inflammatory alopecia, and two with alopecia areata-like lesions. Seventeen (85.0%) patients discontinued their anti-TNFα therapy due to the alopecia, all presented hair regrowth within six months. Hair regrowth was not recorded in three patients who continued TNFα inhibitors. Literature review of pediatric TNFα inhibitor-induced alopecia revealed comparable patients' demographics and response to treatment discontinuation. In conclusion, TNFα inhibitor-induced alopecia is a rare adverse event in children, occurring mainly in adolescents with inflammatory bowel diseases. Our relatively large cohort provides further evidence for the need for TNFα inhibitor cessation to improve drug-induced alopecia in pediatric patients.