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Evaluation of the reimbursement criteria for biological therapies for psoriasis in the Netherlands

testosterone levels returned to normal ranges. Hypertrichosis is an uncommon and distressing reaction to drugs. Its mechanisms are poorly understood, but hair growth usually reverts back to normal after discontinuation of the drug. The disorder starts on the upper limbs or the face and spreads to the back and lower limbs, but spares the elbows, knees and gluteal area, as in our patient. Efalizumab has not been associated with hypertrichosis but the increased levels of free testosterone in our patient might have been caused by an androgen-dependent mechanism induced by the drug. A reversible increase in the circulating lymphocyte count was also observed and it is a matter of further investigation to determine whether or not this is associated with efalizumab’s systemic (or extensive?) adverse reactions. Efalizumab-induced hypertrichosis represents a new adverse reaction. It is not necessary to terminate efalizumab therapy and hypertrichosis may be treated with various methods of hair removal. Physicians should be aware of this and inform their patients accordingly.