Psoriasis and Psoriasiform Eruptions in Pediatric Patients with Inflammatory Bowel Disease Treated with Anti-Tumor Necrosis Factor Alpha Agents

Pediatr Dermatol. 2017 May;34(3):253-260. doi: 10.1111/pde.13081. Epub 2017 Feb 17.


Background: Anti-tumor necrosis factor alpha (TNF-α) agents are used to treat a variety of autoimmune and inflammatory conditions, including psoriasis. Paradoxically, numerous reports have documented new-onset or exacerbation of psoriasis or psoriasiform skin lesions (PSO) in patients treated with these agents for conditions other than PSO-particularly in adults with inflammatory bowel disease (IBD). Not much is known regarding similar cases in children.

Methods: A retrospective chart review was performed on children younger than 19 years of age with IBD seen at the Mayo Clinic between 2003 and 2015 who developed new-onset or recurrent PSO while undergoing anti-TNF-α therapy.

Results: Fourteen children developed PSO while undergoing anti-TNF-α therapy for IBD. All three anti-TNF-α agents (infliximab, adalimumab, certolizumab) used to treat IBD in this series led to induction or recurrence of PSO lesions. The median time to development of PSO was 11 months (range 0-48 mos), the median age was 15 years (range 12.5-17.5 yrs), and 57% of patients were male. IBD activity was quiescent in 93% of cases at PSO onset. Seven patients (50%) discontinued their initial anti-TNF-α therapy because of their skin disease. Ultimately, four patients (29%) had to discontinue all anti-TNF-α therapy to induce PSO resolution.

Conclusion: TNF-α antagonist-induced PSO in children with IBD is a rarely reported adverse reaction. PSO onset has a variable latency, but usually occurs during IBD remission, with a slight male bias. Nearly half of patients required a change in their initial anti-TNF-α agent despite conventional skin-directed therapies, and one-third of patients discontinued all anti-TNF-α therapy because of PSO.

MeSH terms

  • Academic Medical Centers
  • Adalimumab / adverse effects
  • Adalimumab / therapeutic use
  • Adolescent
  • Age Distribution
  • Antibodies, Monoclonal, Humanized / adverse effects*
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Child
  • Cohort Studies
  • Colitis, Ulcerative / diagnosis
  • Colitis, Ulcerative / drug therapy
  • Crohn Disease / diagnosis
  • Crohn Disease / drug therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Inflammatory Bowel Diseases / diagnosis
  • Inflammatory Bowel Diseases / drug therapy*
  • Infliximab / adverse effects
  • Infliximab / therapeutic use
  • Male
  • Prevalence
  • Psoriasis / chemically induced*
  • Psoriasis / epidemiology*
  • Psoriasis / pathology
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Sex Distribution
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • United States
  • Young Adult


  • Antibodies, Monoclonal, Humanized
  • Tumor Necrosis Factor-alpha
  • Infliximab
  • Adalimumab