Psoriasis induced by infliximab in a patient suffering from Crohn's disease

Int J Immunopathol Pharmacol. Jul-Sep 2009;22(3):841-4. doi: 10.1177/039463200902200331.

Abstract

We describe the case of a 30-year-old female with no family history of psoriasis and suffering from Crohn's disease successfully treated with infliximab at the dosage of 5 mg/kg. On the 15th week from the start of therapy, the patient developed a palmoplantar pustular psoriasis, which spread to the arms, trunk and scalp with erythematosquamous plaques. Deeming the dermatitis onset due to the anti-TNF-alpha, we decided to discontinue infliximab, while starting with a topical therapy with emollients and corticosteroids and a systemic therapy with cyclosporine. These treatments achieved a clear improvement of psoriasis after 2 months and a complete regression of skin lesions after 4 months. Several cases have been reported of psoriasis induced by anti-TNF-alpha, which have shown to exert an effective therapeutic action on this disease. The pathogenic mechanism of such a paradoxical effect has not yet been explained, though a number of hypotheses were proposed, among which one of the most intriguing is that the rapid and strong blockade of TNF-alpha could result in an enhancement of INF-alpha activity with consequent induction of psoriasis.

Publication types

  • Case Reports
  • Letter

MeSH terms

  • Administration, Cutaneous
  • Adrenal Cortex Hormones / administration & dosage
  • Adult
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents / adverse effects*
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / adverse effects*
  • Crohn Disease / drug therapy*
  • Crohn Disease / immunology
  • Cyclosporine / administration & dosage
  • Emollients / administration & dosage
  • Female
  • Gastrointestinal Agents / administration & dosage
  • Gastrointestinal Agents / adverse effects*
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Infliximab
  • Infusions, Intravenous
  • Psoriasis / chemically induced*
  • Psoriasis / drug therapy
  • Psoriasis / pathology
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors

Substances

  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • Antibodies, Monoclonal
  • Emollients
  • Gastrointestinal Agents
  • Immunosuppressive Agents
  • Tumor Necrosis Factor-alpha
  • Cyclosporine
  • Infliximab