Review article: dermatological complications of immunosuppressive and anti-TNF therapy in inflammatory bowel disease

Abstract

Summary Background With the expanding list of medications available to treat patients with inflammatory bowel disease (IBD), it is important to recognise adverse events, including those involving the skin. Dermatological adverse events may be confused with extra‐intestinal manifestations of IBD. Aim To review drug‐related dermatological manifestations associated with immunosuppressive and anti‐tumour necrosis factor (anti‐TNF) therapy. Methods The literature was searched on PubMed for dermatological adverse events in IBD. Results Present thiopurine exposure was associated with a 5.9‐fold [95% confidence interval (CI), 2.1–16.4] increased risk of developing non‐melanoma skin cancer (NMSC). The peak incidence is highest in Caucasians over the age of 65 years with crude incidence rates of 4.0 and 5.7/1000 patient‐years for present and previous use. In anti‐TNF‐exposed subjects, drug‐induced lupus was reported in 1% of the cases and a psoriatic rash in up to 3% of the cases. Anti‐TNF monotherapy increases the risk of NMSC ~2‐fold to a rate of 0.5 cases per 1000 person‐years. Cutaneous lymphomas have been rarely reported in subjects on thiopurine or anti‐TNF drug monotherapy. Combination therapy seems to have an additive effect on the risk of developing NMSC and lymphoma. Conclusions Physicians need to be aware of the wide spectrum of dermatological complications of immunosuppressive and anti‐TNF therapy in IBD, especially psoriasis and non‐melanoma skin cancer. Vigilance and regular screening for non‐melanoma skin cancer is recommended. Case discussions between gastroenterologists and dermatologists should be undertaken to best manage dermatological adverse events.

Cumulative Incidence of, Risk Factors for, and Outcome of Dermatological Complications of Anti-TNF Therapy in Inflammatory Bowel Disease: A 14-Year Experience

“…Th e broader and prolonged use of these immunosuppressive therapies could expose patients to an increased risk of adverse reactions. Among them, dermatological complications include immune-mediated diseases, such as lupus or vasculitis, infections, and skin cancers (4)(5)(6). Although anti-TNF agents are eff ective for the treatment of psoriasis, psoriasiform lesions are the most frequent dermatological adverse reactions linked to the use of anti-TNF therapy ( 4 ).…”

“…In IBD, anti-TNF-induced skin adverse reactions are essentially described in case series ( 5,13,(16)(17)(18)(19), with an estimated prevalence of 1.6-22% of patients ( 13,(18)(19)(20)(21)(22). In a recent 2-year prospective study performed on 84 pediatric patients with IBD, nearly half of them suff ered from skin lesions related to anti-TNF ( 23 ).…”

Reactive Granulomatous Dermatitis during Anti-TNF Therapy: A Case Report and Review of the Literature

“…Drug induced skin lesions represent the most frequent side effect of anti-TNFα agents, presumably in susceptible individuals [3][4][5][6][7][8][9][10]. They include infusion/ injection site reactions, psoriasis and psoriasis-like lesions, lupus-like syndromes, vasculitis, cutaneous infections, eczematous reactions, lichenoid reactions, cutaneous lymphomas, skin cancers and granulomatous diseases [5][6][7][8][9][10].…”

“…They include infusion/ injection site reactions, psoriasis and psoriasis-like lesions, lupus-like syndromes, vasculitis, cutaneous infections, eczematous reactions, lichenoid reactions, cutaneous lymphomas, skin cancers and granulomatous diseases [5][6][7][8][9][10]. Many noninfectious cutaneous granulomatous reactions have been described in literature, such as granuloma annulare, cutaneous sarcoidosis and sarcoid-like granulomatosis [11,12].…”

Metabolism of Anandamide by Human Cytochrome P450 2J2 in the Reconstituted System and Human Intestinal Microsomes

“…IBD is characterized by severe diarrhea, abdominal pain, fatigue, nausea, and weight loss due to malnutrition. Moreover, a person diagnosed with IBD has an increased risk of developing colon cancer (Moran et al, 2013;Chang et al, 2014;Seo and Chae, 2014). Although the cause(s) of IBD is unknown, studies suggest that autoimmune reactions, genes, and the environment all may contribute to its development (Kozak et al, 2002b;Stanley and O'Sullivan, 2014;Curkovic et al, 2013;Yarlas et al, 2015).…”