{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T01:36:24Z","timestamp":1789436184085,"version":"build-2803163510"},"reference-count":9,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,7,20]]},"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:p>Calcitonin gene-related peptide (CGRP) inhibitors, in the form of injectable monoclonal antibodies, are a newer class of drugs for the prevention of migraine headaches. In clinical trials, they have been found to be effective with good tolerance and few adverse effects. Alopecia has been increasingly noted as a post-marketing event associated with CGRP inhibitor injectables. Of the case reports available on this topic, alopecia has commonly been localised to the scalp and associated with erenumab use; however, not as much has been reported for fremanezumab nor for injection site-related alopecia. We report an occurrence of persistent lower extremity localised injection site alopecia in a patient within our headache clinic who used fremanezumab. The possible mechanism of alopecia may be related to the failure of hair follicle immune privilege in the absence of CGRP immunomodulatory effects.<\/jats:p>","DOI":"10.1136\/bcr-2024-260741","type":"journal-article","created":{"date-parts":[[2024,8,12]],"date-time":"2024-08-12T07:56:26Z","timestamp":1723449386000},"page":"e260741","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Fremanezumab-associated injection site alopecia"],"prefix":"10.1136","volume":"17","author":[{"given":"Mark","family":"Esguerra","sequence":"first","affiliation":[{"name":"Internal Medicine, Scripps Clinic \/ Scripps Green Hospital, La Jolla, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily Rubenstein","family":"Engel","sequence":"additional","affiliation":[{"name":"Dalessio Headache Center, Scripps Clinic Division of Neurology, La Jolla, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,8,12]]},"reference":[{"key":"2025082700573991000_17.8.e260741.1","first-page":"S3","article-title":"Calcitonin gene-related peptide (CGRP) and migraine","volume":"46 Suppl 1","author":"Durham","year":"2006","journal-title":"Headache"},{"key":"2025082700573991000_17.8.e260741.2","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-018-0003-1"},{"key":"2025082700573991000_17.8.e260741.3","doi-asserted-by":"crossref","first-page":"3331024221143538","DOI":"10.1177\/03331024221143538","article-title":"Alopecia as an emerging adverse event to CGRP monoclonal antibodies: cases series, evaluation of FAERS, and literature review","volume":"43","author":"Ruiz","year":"2023","journal-title":"Cephalalgia"},{"key":"2025082700573991000_17.8.e260741.4","doi-asserted-by":"crossref","unstructured":"Gao B , Sun N , Yang Y , et al . Safety and efficacy of fremanezumab for the prevention of migraine: A meta-analysis from randomized controlled trials. Front Neurol 2020;11. doi:10.3389\/fneur.2020.00435","DOI":"10.3389\/fneur.2020.00435"},{"key":"2025082700573991000_17.8.e260741.5","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1111\/head.14427","article-title":"Effluvium and alopecia associated with monoclonal calcitonin gene-related peptide antibody use","volume":"63","author":"Evers","year":"2023","journal-title":"Headache"},{"key":"2025082700573991000_17.8.e260741.6","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1177\/12034754231188444","article-title":"A systematic review and meta-analysis of injection site reactions in randomized-controlled trials of biologic injections","volume":"27","author":"Kim","year":"2023","journal-title":"J Cutan Med Surg"},{"key":"2025082700573991000_17.8.e260741.7","doi-asserted-by":"crossref","DOI":"10.1186\/s10194-021-01330-7","article-title":"Inflammatory complications of CGRP monoclonal antibodies: a case series","volume":"22","author":"Ray","year":"2021","journal-title":"J Headache Pain"},{"key":"2025082700573991000_17.8.e260741.8","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.npep.2012.07.008","article-title":"Effects of calcitonin gene-related peptide on the immune privilege of human hair follicles","volume":"47","author":"Pi","year":"2013","journal-title":"Neuropeptides"},{"key":"2025082700573991000_17.8.e260741.9","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0625.2011.01432.x"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-260741","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:57:48Z","timestamp":1756281468000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-260741"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8]]},"references-count":9,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8,12]]},"published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1136\/bcr-2024-260741"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-260741","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8]]}}}