Adverse cutaneous reactions induced by TNF-alpha antagonist therapy

South Med J. 2009 Nov;102(11):1133-40. doi: 10.1097/SMJ.0b013e3181bb554c.

Abstract

Objective: To review adverse cutaneous drug reactions induced by tumor necrosis factor alpha (TNF-alpha) antagonist therapy.

Methods: A literature search was performed using PubMed (1996-March 2009), EMBASE, and selected MEDLINE Ovid bibliography searches. All language clinical trial data, case reports, letters, and review articles identified from the data sources were used.

Results: Since the introduction of TNF-alpha antagonist, the incidence of adverse cutaneous drug reactions has increased significantly. A wide range of different skin lesions might occur during TNF-alpha antagonist treatment. New onset or exacerbation of psoriasis has been reported in patients treated with TNF-alpha antagonists for a variety of rheumatologic conditions. TNF-alpha antagonist therapy has been associated with a lupus-like syndrome; most of these case reports occurred in patients receiving either etanercept or infliximab. Serious skin reactions such as erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis have been reported rarely with the use of TNF-alpha antagonists.

Conclusions: As the use of TNF-alpha antagonists continues to increase, the diagnosis and management of cutaneous side effects will become an increasingly important challenge. In patients receiving TNF-alpha antagonist treatment, skin disease should be considered, and clinicians need to be aware of the adverse reactions of these drugs.

Publication types

  • Review

MeSH terms

  • Adalimumab
  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal, Humanized
  • Certolizumab Pegol
  • Etanercept
  • Humans
  • Immunoglobulin Fab Fragments / adverse effects
  • Immunoglobulin G / adverse effects*
  • Immunosuppressive Agents / adverse effects*
  • Infliximab
  • Lupus Erythematosus, Cutaneous / chemically induced
  • Polyethylene Glycols / adverse effects
  • Psoriasis / chemically induced
  • Receptors, Tumor Necrosis Factor
  • Skin / drug effects*
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Immunoglobulin Fab Fragments
  • Immunoglobulin G
  • Immunosuppressive Agents
  • Receptors, Tumor Necrosis Factor
  • Tumor Necrosis Factor-alpha
  • Polyethylene Glycols
  • Infliximab
  • Adalimumab
  • Etanercept
  • Certolizumab Pegol