Psoriasiform Eruptions During Anti–TNF-α Treatment: Psoriasis or Not?

Paradoxical reactions and biologic agents: a French cohort study of 9303 patients

“…4,[6][7][8] Clinically and histologically, patients with paradoxical psoriasis present eczematous, lichenoid or psoriasiform patterns, which suggests that paradoxical skin reactions differ from those of conventional psoriasis or atopic dermatitis. 9 This hypothesis agrees with the leading pathogenetic explanation suggesting that TNF-a blockade induces interferon-a overproduction, with major differences from conventional skin disease pathogenesis. [10][11][12] Since 2004, other PRs have been reported, such as IBD, 13 chronic inflammatory rheumatism, 14,15 hidradenitis suppurativa, 16 sarcoidosis and uveitis.…”

“…PRs occur after a median of 6–11 months, 5 mainly in women and smokers 4,6–8 . Clinically and histologically, patients with paradoxical psoriasis present eczematous, lichenoid or psoriasiform patterns, which suggests that paradoxical skin reactions differ from those of conventional psoriasis or atopic dermatitis 9 . This hypothesis agrees with the leading pathogenetic explanation suggesting that TNF‐α blockade induces interferon‐α overproduction, with major differences from conventional skin disease pathogenesis 10–12 …”

Cutaneous side effects of anti–tumor necrosis factor biologic therapy: A clinical review

“…Histologic examination revealed infiltration by lymphocytes and histiocytes of a lichenoid pattern accompanied by focal necrotic keratinocytes. 49 A lichenoid-type histology was also reported by Senechal et al, 48,49 who described a CD8-positive inflammatory infiltration in 3 patients with psoriasiform eruption after anti-TNF treatment.…”

Learning the Lessons of Antitumour Necrosis Factor Therapy-Associated Psoriasis

“…While skin biopsy in the majority of cases confirms features of psoriasis, some have noted atypical findings supporting the concept that such lesions actually represent a psoriasiform drug reaction (16). Furthermore, patch testing with topically applied anti-TNF drugs was reported to reproduce histologically comparable skin lesions following the occurrence of anti-TNF-associated psoriasis in four of eight patients investigated (17). However, such a theory would not adequately explain cases in which skin disease continues after treatment withdrawal, or those that recur when using a different anti-TNF drug.…”