Encyclopedia · drug with hair side effects
TNF inhibitors (adalimumab, infliximab, etanercept)
Anti-inflammatory biologics that can paradoxically trigger alopecia areata or scarring hair loss, even though etanercept regrew no hair in any of 17 patients when tested as an alopecia areata treatment.
What it is
Prescription biologic drugs for inflammatory bowel disease, arthritis and psoriasis.
How it works
Unclear. Activation of self-reactive T cells has been proposed.
What the studies show
- In nine French patients, alopecia areata appeared 6 weeks to 8 months after starting adalimumab (8) or etanercept (1). Five regrew completely after stopping, and 4 had total scalp loss. Le Bidre 2011
- Two case reports describe alopecia with alopecia areata and psoriasis features on anti-TNF therapy. Ribeiro 2015
- One case report describes infliximab-induced lichen planopilaris with progressive global hair loss. McPhie 2020
- In an open-label trial of 17 patients, etanercept 50 mg twice weekly for 8-24 weeks gave no significant regrowth in any subject. Strober 2005
How it's used in studies
Etanercept 50 mg by injection twice weekly in the alopecia areata trial.
Side effects and safety
The hair effects are rare and causation is uncertain; coincidence cannot be ruled out.
Bottom line
Mostly case reports. New patchy hair loss on a biologic is worth reporting to the prescriber. Discuss with a doctor.
Fun facts
- A drug that failed as an alopecia areata treatment has also been reported to cause it, and hair regrew in five of nine patients once the drug stopped. Le Bidre 2011
Studies 4
Le Bidre E et al. Alopecia areata during anti-TNF alpha therapy: nine cases. Ann Dermatol Venereol. 2011
Result: Alopecia areata appeared 6 weeks to 8 months after starting adalimumab (8) or etanercept (1); complete regrowth in 5 after stopping.
Read the study ↗Ribeiro LB et al. Alopecia secondary to anti-tumor necrosis factor-alpha therapy. An Bras Dermatol. 2015
Result: Alopecia with alopecia areata and psoriatic features on anti-TNF therapy.
Read the study ↗McPhie ML et al. Lichen planopilaris induced by infliximab. SAGE Open Med Case Rep. 2020
Result: Infliximab-induced lichen planopilaris with progressive global alopecia.
Read the study ↗Strober BE et al. Etanercept does not effectively treat moderate to severe alopecia areata: an open-label study. J Am Acad Dermatol. 2005
Tested: etanercept 50 mg twice weekly
Result: No significant regrowth in any subject.
Read the study ↗Related
- DupilumabAn eczema antibody that halted worsening of alopecia areata in a 40-person phase 2a trial, especially in people with high IgE, although absolute regrowth rates were modest.
- TofacitinibThe first JAK inhibitor used off-label for alopecia areata; about a third to two thirds of patients regrow hair in open-label studies, but most relapse within months of stopping.
- BaricitinibA once-daily pill that was the first drug approved for severe alopecia areata, regrowing hair in about a third of patients while they keep taking it.