Psoriasis induced by anti–tumor necrosis factor therapy: A paradoxical adverse reaction

Abstract

Administration of anti-tumor necrosis factor (anti-TNF) agents is beneficial in a variety of chronic inflammatory conditions, including psoriasis. We describe 5 patients in whom psoriasiform skin lesions developed 6-9 months after the initiation of anti-TNF therapy for longstanding, seropositive rheumatoid arthritis (etanercept or adalimumab), typical ankylosing spondylitis (infliximab), and Adamantiades-Behçet's disease (infliximab). In all 5 patients, the underlying disease had responded well to anti-TNF therapy. Four patients developed a striking pustular eruption on the palms and/or soles accompanied by plaque-type psoriasis at other skin sites, while 1 patient developed thick erythematous scaly plaques localized to the scalp. In 3 patients there was nail involvement with onycholysis, yellow discoloration, and subungual keratosis. Histologic findings from skin biopsies were consistent with psoriasis. None of these patients had a personal or family history of psoriasis. In all patients, skin lesions subsided either with topical treatment alone, or after discontinuation of the responsible anti-TNF agent. The interpretation of this paradoxical side effect of anti-TNF therapy remains unclear but may relate to altered immunity induced by the inhibition of TNF activity in predisposed individuals.

Clinical experience of combination therapy of infliximab and total glucosides of paeony for severe psoriasis with liver disorder history

“…To our surprise, anti-TNF medications may also induce psoriasiform skin lesions [24] . Grinblat and Scheinberg reviewed the literature of this phenomenon between 2005 and 2007, and reported that more than 25 cases of all 50 cases were associated with the application of infliximab [25] .…”

Diffused suberitrodermic psoriasis induced by infliximab

“…Ad oggi si conoscono circa 50 casi descritti in letteratura di psoriasi indotta da inibitori del TNF-alfa. Sebbene circa la metà siano secondari all'uso di Infliximab, la restante parte è attribuibile all'uso di Etanercept ed Adalimumab, evidenziando quindi che si tratta di un effetto collaterale di classe e non di molecola (8,11). Nessun caso di psoriasi diffusa suberitrodermica è stato finora descritto, men- tre tutti i casi descritti appartengono alle varianti volgare, pustolosa palmo-plantare, guttata e a placche.…”

“…sti ultimi anni siano stati segnalati alcuni casi di induzione di Psoriasi da parte di questi agenti, in soggetti senza precedente storia né familiarità per la malattia (4)(5)(6)(7)(8)(9)(10). Riportiamo il caso di un paziente affetto da M. di Crohn con spondiloartrite reattiva, che ha sviluppato una psoriasi diffusa suberitrodermica dopo terapia con Infliximab.…”

New Treatment Alternatives in the Management of Non-İnfectious İntraocular İnflammations: Biologic Agents

“…119 Yukar›da bahsedilen biyolojik ajanlar›n kullan›m endikasyonlar›ndan biri de psoriazis veya psoriatik artrit olmakla beraber, literatürde ilaç kullan›m›na ba¤l› olarak psoriazis-benzeri bir klinik antitenin indüklenebildi¤ini belirten yay›nlar mevcuttur. [120][121][122] Bu konuda yay›nlan-m›fl en büyük serilerden birinde 9826 RA hastas›n›n ortalama 2,81 y›ll›k anti-TNF ajan kullan›m› süresince yeni psoriasis tablosu yaln›zca 27 olguda bildirilmifltir. Burada ki önemli bir nokta ise, etanerseptin var olan psoriazisi alevlendirirken, antikor fleklindeki antagonistlerin psoriazisi indüklemeleridir.…”