Paradoxical psoriasis in pediatric patients: A systematic review

Abstract

Background: Paradoxical psoriasis occurs in pediatric patients following treatment with biologic agents. These presentations are not well described, and optimal treatment strategies have not been established. Objective:To describe the reported rates, demographic characteristics, clinical presentation, and treatment options for TNFα inhibitor-induced psoriasis.Methods: Systematic review of published cases and cohort studies of paradoxical psoriasis induced by biologic agents, with specific reference to TNFα inhibitors. Results:We identified 4564 pediatric patients treated with TNFα inhibitors, of whom 210 (4.6%) developed paradoxical psoriasis. Infliximab was the drug most likely to induce psoriasis (8.3%), followed by adalimumab (3.3%). Individual-level data were acquired from 129 individuals with a mean age of 13.6 years (SD: 4.0); 45.0% were male. The scalp was the most commonly affected area (47.5%), followed by the ears (30.8%). Most (63.3%) patients were continued on TNFα inhibitor therapy. Among those who switched TNFα inhibitors, only 32.0% had complete clearance of their skin lesions. Among patients who were switched to a non-TNFα inhibitor, 81% had complete clearance of their paradoxical psoriasis.Limitations: Data were acquired from retrospective studies including case reports and case series. Conclusion:TNFα inhibitor-induced psoriasis is a common adverse effect; however, most patients can continue their original therapy and be managed with skin-directed topical or systemic medications. If a patient requires medication discontinuation, switching to a new TNFα inhibitor is unlikely to lead to resolution of their skin lesions.

Paradoxical Psoriasiform Eruptions in Children Receiving Tumor Necrosis Factor α Inhibitors

“…In this multicenter case series, we identified TNF inhibitor–induced psoriasiform eruptions in children treated for several conditions, in addition to IBD, highlighting the need to consider this paradoxical reaction among any child treated with a TNF inhibitor. The prevalence of pediatric TNF inhibitor–induced psoriasiform dermatitis ranges from 5.8% to 10.5% among children with IBD and 5.4% among those with juvenile inflammatory arthritis, excluding the outlying study by Mälkönen et al with a prevalence of 35.7% among children with IBD only treated with infliximab . All 3 TNF inhibitors used in this cohort (infliximab, adalimumab, and certolizumab pegol) were associated with TNF inhibitor–induced psoriasiform eruptions, thus suggesting a class effect.…”

Tumor necrosis factor inhibitors and janus kinase inhibitors in the treatment of cicatricial alopecia: A systematic review

“…Recent literature expounded that people with a background of rheumatological or gastrointestinal disorders may experience induced new-onset psoriasis while receiving TNF inhibitors. Reversible alopecia was a random AE of treatment with TNF inhibitors [83,84]. Compared to these studies, our systematic review focused on using TNF and JAK inhibitors in treating CA, a more severe, scarring, and difficult-to-treat type of alopecia.…”

Psoriasis in children and adolescents

“…Auch bei der als „paradoxe Psoriasis“ bezeichneten Induktion psoriasiformer Läsionen durch TNF-α-Inhibitoren weisen die Herde oft eine ekzematöse Komponente mit Exsudation, Nässen und Superinfektion auf. In einer Metaanalyse trat eine paradoxe Psoriasis nach einer durchschnittlichen Latenzzeit von 22 Monaten bei 8,3 % der mit Infliximab und 3,3 % der mit Adalimumab behandelten Kinder auf, die diese Medikamente aufgrund einer entzündlichen Darmerkrankung, einer juvenilen idiopathischen Arthritis oder einer chronisch rezidivierenden multifokalen Osteomyelitis erhielten [ 5 ]. Am häufigsten waren Kopfhaut und Ohren bzw.…”