Five Cases of Anti‐Tumor Necrosis Factor Alpha–Induced Psoriasis Presenting with Severe Scalp Involvement in Children

Abstract

Although anti-tumor necrosis factor alpha (TNF-α) agents are commonly used to treat psoriasis and other inflammatory diseases in adults and children, numerous reports have documented new-onset or flaring psoriasis in adults treated for the other conditions. Individual case reports have documented similar observations in three children. We report a series of anti-TNF-α-induced psoriasis in children with juvenile idiopathic arthritis or inflammatory bowel disease treated at a large children's hospital. All five patients presented with severe scalp involvement. One child was treated with adalimumab for juvenile idiopathic arthritis, and four received infliximab for inflammatory bowel disease. The five patients developed psoriasis 2 to 10 months after initiating anti-TNF-α therapy. They presented with erythematous, scaly, crusted scalp lesions. Three of the five patients were initially treated with griseofulvin for presumed tinea capitis. The anti-TNF-α agent was discontinued at the time of diagnosis in two cases. Topical steroids were the mainstay of psoriasis therapy, with improvement in four of five patients. Anti-TNF-α agents have been associated with the onset or worsening of psoriasis in adults, but this has rarely been reported in children. We describe five pediatric cases of anti-TNF-α-induced psoriasis presenting with severe scalp involvement and review their subsequent management. We hope that clinicians caring for patients receiving anti-TNF-α agents will consider psoriasis from the onset of cutaneous symptoms and institute appropriate therapy or referral.

The onset of psoriasis during the treatment of inflammatory bowel diseases with infliximab: should biological therapy be suspended?

“…They were females (47.83%), with a mean age of 27.11 years and did not report a personal and/or family history of psoriasis (84.05%). In three patients, pre-existing psoriasis was exacerbated (25,26) , and in three others, there was a positive family history of psoriasis (12,29,30) . …”

Skin Reactions During Anti-TNFα Therapy for Pediatric Inflammatory Bowel Disease

“…9 Similar studies on children include few patients and consist only of retrospective data. [11][12][13][14][15] Thus, we conducted a prospective study in which the occurrence of skin manifestations was systematically registered during a 2-year period among pediatric patients with IBD who received IFX therapy.…”

Anti-TNF-Alpha Induced Psoriasiform Eruptions with Severe Scalp Involvement and Alopecia: Report of Five Cases and Review of the Literature

“…To our knowledge, 10 cases of psoriasiform eruptions induced alopecia during anti-TNF-α therapy have been previously published [3,4,5,6]. Table 1 describes these cases plus those newly reported herein, totaling 5 males and 10 females.…”