Pityriasis versicolor during anti‐TNF‐α monoclonal antibody therapy: therapeutic considerations

Abstract

Anecdotal reports have shown that tumour necrosis factor (TNF)-α inhibition may cause unchecked superficial infection with the microorganisms responsible for pityriasis versicolor (PV). We observed several cases of PV, which is frequently resistant to topical therapies, in psoriatic patients undergoing anti-TNF-α monoclonal antibody therapy. To evaluate the incidence and the therapeutic management of PV in this group of individuals, between 1 January and 27 December 2010, we examined 153 psoriatic patients for the hypopigmented/hyperpigmented macular and scaling lesions associated with PV. All patients positive for PV were given topical therapy with miconazole nitrate cream twice daily for 28 days, after which they were re-evaluated. In patients non-responsive to topical therapy, we started systemic therapy with fluconazole, 300 mg week(-1) for 3 weeks. We diagnosed seven cases of PV. At the end of topical treatment, complete healing of lesions was observed in only one patient. In the other six patients, systemic treatment led to complete resolution of the infection. Although the onset of PV during anti-TNF-α therapy is seldom reported, it is not likely to be rare, but rather under-reported because of its limited pathological significance. In our opinion, the therapeutic management of this condition deserves greater consideration, as the use of topical treatments alone is largely ineffective compared with systemic treatment.

Interdigital Psoriasis of the Feet (Psoriasis Alba): Not a Distinct Form of Psoriasis

“…Remarkably our population showed a low proportion of IFI; however, very few cases of superficial fungal infection in psoriatic patients receiving systemic therapy have been reported in the literature, and further investigations are needed to investigate this aspect [7,8,9]. …”

Off‐label use of tumour necrosis factor‐alpha inhibitors and anakinra at an Australian tertiary hospital

“…In our audit, the most common adverse reactions were administration site reactions and infection. We also saw a case of tinea versicolor, previously reported . The observational design made it difficult to compare rates of adverse events in our study with previous research.…”

Pityriasis Versicolor: host susceptibility in relation to IL-10 and IFN γ cytokine gene polymorphism

“…These studies on the host factors could pave the way for determining the changing trend of individual-based diagnosis and future treatment. 23 The understanding of the disease pathogenesis of PV has been a topic of debate as the Malassezia yeasts, a known commensal, is responsible to cause symptoms in only a subset of the population who are colonized with it. Our study was able to provide an understanding of the susceptibility of this subset of the population by comparing their genetic profile with the normal population through a study of the cytokine gene polymorphism in the IL10 and IFN γ SNPs.…”