A 52-year-old woman with a 10-pack-year smoking history presented with serious hair loss. She had a 10-year history of Crohn's disease associated with arthritis, for which she had been taking adalimumab. After 2 months of this treatment, she developed pustular lesions on her palms, soles, and scalp. Her gastroenterologist discontinued adalimumab injections, ordered skin biopsy, and switched her to ustekinumab 90-mg subcutaneous injections every 8 weeks. She then presented to our dermatology clinic, 2 months following the initiation of anti-IL12/23 medications, for her alopecia. She had no personal or family history of psoriasis. (SKINmed. 2022;20:136-138).