Psoriasiform Skin Lesions Are Caused by Anti-TNF Agents Used for the Treatment of Inflammatory Bowel Disease

Abstract

Anti-TNF-induced psoriasiform lesions developed in 3.5% of patients with IBD at a tertiary referral center. Similar to prior published studies, most patients were female, had involvement of the palmo-plantar and scalp regions, and did not have severe IBD activity. The presence of upper tract disease was associated with the development of psoriasiform lesions. Skin lesions led to discontinuation of anti-TNF therapy in 50% of patients. Based upon these results, IBD providers should educate patients about this adverse effect, refer to dermatology for treatment, and discuss alternative IBD therapeutic options early if a severe psoriasiform rash develops.

Clinical management of Anti‐TNF‐alpha‐induced psoriasis or psoriasiform lesions in inflammatory bowel disease patients: a systematic review

“…For this reason, it has been widely used in the included studies. However, results are variable, and most studies report an unfavorable response . Accordingly, in our experience, the use of MTX in the management of psoriasiform lesions has been somewhat disappointing.…”

“…For this reason, it is not consensual if another anti‐TNF‐ α should be attempted or a different therapeutic class should be considered. A wide range of recurrence rates after a second anti‐TNF‐ α agent was observed in different studies . In spite of an important risk of recurrence, two of the included studies recommended a switch to a second anti‐TNF‐ α drug.…”

“…Probably one of the most important findings of this review that has been consistently reported in many studies is the association of the onset of dermatological reactions with periods of IBD remission. Around 88–93% of patients had quiescent or mild disease activity at the time of psoriasis development, as attested by low levels of fecal calprotectin (FC) and low PGA (Physician's Global Assessment) or other activity markers (C‐reactive protein and albumin) …”

Polyunsaturated Fatty Acids and Their Derivatives: Therapeutic Value for Inflammatory, Functional Gastrointestinal Disorders, and Colorectal Cancer

“…The pathogenesis of IBD is not completely defined, but recently the spotlight is on microbiota-stimulated immunoreactivity and adipose tissue hormonal dysregulation (Kostic et al, 2014; Schaubeck and Haller, 2015). What is more important, the currently available treatment includes 5-aminosalicylates, steroids, biological therapy and surgical procedures—all aggressive and with significant side effects (George et al, 2015; Khanna and Feagan, 2015; Meyer et al, 2015). Thus, it is crucial to seek new agents that could influence the clinical course of IBD and alleviate or prevent exacerbations.…”

Development of paradoxical inflammatory disorders during treatment of psoriasis with TNF inhibitors: a review of published cases

“…4 Conversely, there is no consistent evidence of induction of immune-mediated disorders in patients with psoriasis treated with TNF inhibitors, and the suspicion of such a causal relationship is anecdotal. However, modulation of TNF does raise concern over adverse events, particularly malignancies and infections.…”