Psoriasiform reactions to anti-tumor necrosis factor α therapy

J Clin Rheumatol. 2013 Oct;19(7):377-81. doi: 10.1097/RHU.0b013e3182a702e8.

Abstract

Objective: Given increasing concern about the adverse effects of anti-tumor necrosis factor α (anti-TNF-α) medications, we sought to characterize psoriasiform eruptions in patients on these medications.

Methods: In a retrospective review of patients at the Brigham and Women's Hospital combined dermatology-rheumatology clinic, we identified 13 patients (1 male and 12 female patients) who developed psoriasiform eruptions while on anti-TNF-α medications.

Results: Inciting medications were adalimumab, etanercept, and infliximab. Patients were on their inciting medication for a median time of 24 months and a mean time of 31.3 months before developing eruptions. Five of 7 patients experienced complete resolution of lesions with topical corticosteroids and discontinuation of anti-TNF-α medications with the remaining 2 patients having partial improvement. One of the other 6 patients experienced complete resolution with topical corticosteroid treatment only, with the remaining 5 patients experiencing partial improvement. After changing anti-TNF-α agents, 1 patient had partial improvement of psoriasiform lesions, and 7 patients had no improvement.

Conclusions: All of the main anti-TNF-α medications currently used are capable of causing psoriasiform eruptions. Poor responders to topical agents, such as corticosteroids, may benefit from supplemental therapy aimed at the psoriasiform eruption or changing to a different class of immunomodulatory agents. Switching anti-TNF-α medications had a low likelihood of improving psoriasiform skin reactions, further suggesting that these eruptions are a drug class effect.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adalimumab
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Anti-Inflammatory Agents / adverse effects*
  • Anti-Inflammatory Agents / therapeutic use
  • Antibodies, Monoclonal / adverse effects
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Humanized / adverse effects
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Arthritis, Rheumatoid / drug therapy*
  • Etanercept
  • Female
  • Follow-Up Studies
  • Humans
  • Immunoglobulin G / adverse effects
  • Immunoglobulin G / therapeutic use
  • Infliximab
  • Male
  • Middle Aged
  • Prevalence
  • Psoriasis / chemically induced*
  • Psoriasis / drug therapy
  • Psoriasis / epidemiology
  • Receptors, Tumor Necrosis Factor / therapeutic use
  • Retrospective Studies
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Withholding Treatment

Substances

  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Immunoglobulin G
  • Receptors, Tumor Necrosis Factor
  • Tumor Necrosis Factor-alpha
  • Infliximab
  • Adalimumab
  • Etanercept