Paradoxical Alopecia Areata during Biologic Therapies: A Case Series and Long-Term Follow-Up

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Introduction: Alopecia areata is a non-scarring autoimmune alopecia that may arise as a paradoxical reaction during treatment with biologic agents for immune-mediated inflammatory diseases. Such paradoxical reactions are increasingly recognized with the widespread use of biologics, particularly TNF-α inhibitors. Case Presentation: We report a case series of 7 patients with multiple immune-mediated inflammatory diseases who developed alopecia areata during biologic therapy. Conclusion: There is no consensus on the optimal management of paradoxical alopecia areata. Individualized management should be guided by disease severity, response to treatment, and patient preference. Recognizing patients at higher risk, particularly those with multiple immune-mediated inflammatory diseases, and monitoring them closely may aid in the early detection and management of paradoxical reactions.

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