Spotlight on the treatment armamentarium of concomitant psoriasis and inflammatory bowel disease: a systematic review

Ustekinumab for the treatment of paradoxical skin reactions and cutaneous manifestations of inflammatory bowel diseases

“…EN is usually treated with a combination of corticosteroids and biologics targeting the underlying IBD, while PG treatment typically consists of an initial course of systemic steroids, followed by oral calcineurin inhibitors and in recalcitrant cases, infliximab, or adalimumab 5 . In recent years; however, there has been increasing recognition of paradoxical reactions in response to anti‐TNF‐α therapy 6,8 . Paradoxical reactions to biologics can be defined as the development or exacerbation of a disease that responds to this class of drug while treating the patient for another condition (eg, the development of de novo psoriasis during anti‐TNF‐α therapy for Crohn's disease or a change in psoriasis morphology) 8 .…”

“…5 For instance, patients with psoriasis have a 2.2-fold increased odds of developing Crohn's disease and a 1.6-fold increased odds of developing ulcerative colitis. 6 The cytokines IL-17, IL-23, and TNF-α have been implicated in both psoriasis and IBD, as have microbiome alterations. 6,7 Due to the similar immunological mechanisms in IBD and certain dermatological conditions, numerous studies have examined the efficacy of tumor necrosis factor-alpha (TNF-α) inhibitors (etanercept, infliximab, adalimumab), the mainstays of IBD therapy, for treating the cutaneous manifestations of IBD.…”

“…6 The cytokines IL-17, IL-23, and TNF-α have been implicated in both psoriasis and IBD, as have microbiome alterations. 6,7 Due to the similar immunological mechanisms in IBD and certain dermatological conditions, numerous studies have examined the efficacy of tumor necrosis factor-alpha (TNF-α) inhibitors (etanercept, infliximab, adalimumab), the mainstays of IBD therapy, for treating the cutaneous manifestations of IBD. 5,6 EN is usually treated with a combination of corticosteroids and biologics targeting the underlying IBD, while PG treatment typically consists of an initial course of systemic steroids, followed by oral calcineurin inhibitors and in recalcitrant cases, infliximab, or adalimumab.…”

“…5 In recent years; however, there has been increasing recognition of paradoxical reactions in response to anti-TNF-α therapy. 6,8 Paradoxical reactions to biologics can be defined as the development or exacerbation of a disease that responds to this class of drug while treating the patient for another condition (eg, the development of de novo psoriasis during anti-TNF-α therapy for Crohn's disease or a change in psoriasis morphology). 8 Paradoxical reactions may also be systemic manifestations of a disease, such as, the development of spondylodiscitis in a patient with Crohn's disease receiving anti-TNF-α therapy.…”

TNF-Alpha Inhibitors and Ustekinumab for the Treatment of Psoriasis: Therapeutic Utility in the Era of IL-17 and IL-23 Inhibitors

“…For example, a recent systematic review highlighted the utility of ustekinumab, certolizumab, adalimumab, and infliximab as effective options for the concomitant treatment of psoriasis and inflammatory bowel disease. 158 Due to the shared common inflammatory pathway, these agents were successful in treating both diseases, simultaneously.…”