The Enigmatic Development of Psoriasis and Psoriasiform Lesions During Anti-TNF Therapy: A Review

https://doi.org/10.1016/j.semarthrit.2007.05.004Get rights and content

Objectives

The paradoxical observation that antitumor necrosis factor (anti-TNF) agents are capable of inducing psoriasis and psoriasiform skin lesions while also being therapy for psoriasis gained substantial support following the description of this condition by several authors. Our aim was to review the literature of this subject.

Methods

A retrospective review of the literature was performed using the Medline database between 2005 and February 2007.

Results

Since the first publication by our group in April 2005 to the present, 50 cases of this type of dermatitis have been described. More than half of the cases were associated with the use of infliximab. Different presentations of psoriasis were reported, plaque form being the most prevalent. A number of clinical and immunological observations suggest a cytokine disequilibrium in patients receiving chronic anti-TNF therapy leading to this condition. Treatment for the skin disease includes changing the anti-TNF agent or discontinuing the medication.

Conclusions

The appearance of psoriasis and psoriasiform lesions during chronic anti-TNF therapy is dependent on the presence of known and unknown interrelated factors. Enhanced clinician awareness of this drug complication and further investigation of its mechanisms are warranted.

Section snippets

Methods

We summarized our 2 cases and reviewed the literature by performing a Medline search from April 2005 until February 2007. The terms used in the Medline search were psoriasis and anti-TNF-alpha therapy and psoriasis after the use of TNF-alpha antagonists.

Case 1

A 37-year-old woman with a 20-year history of rheumatoid arthritis developed psoriatic skin lesions after the seventh infusion of infliximab. The lesions were erythematous and scaled plaques on the arms, legs, and scalp, and onycodystrophy in the 20 nails. A skin biopsy of 1 of the leg lesions showed hyperplasia of the epidermis, elongated papillae, parakeratosis, and corneum microabscesses, which was consistent with psoriasis. She was treated with topical corticosteroids and advised to undergo

Discussion

Skin reactions during treatment with anti-TNF-alpha include erythema, edema at the injection site, nonspecific rashes, bullous lesions, and vasculitis (5). In a prospective study of patients receiving anti-TNF-alpha therapy, approximately 10% of the patients developed skin lesions including eczema, drug-related eruptions, drug-induced systemic lupus erythematosus, dermatomyositis, lymphomatoid papulosis-like eruption, and psoriasis (43).

In general, adverse events induced by drug therapy can be

References (44)

  • D.P. Goncalves et al.

    The appearance of pustular psoriasis during antitumor necrosis factor therapy

    J Clin Rheumatol

    (2006)
  • W. Beuthien et al.

    Skin reaction to adalimumab

    Arthritis Rheum

    (2004)
  • S. Kary et al.

    New onset or agravation of psoriatic skin lesions in patients with definite rheumatoid arthritis under treatment with TNF-alpha antagonists: report of 8 cases

    Ann Rheum Dis

    (2004)
  • H. Haibel et al.

    Unexpected new onset or exacerbation of psoriasis in treatment of active ankylosing spondylitis with TNF-alpha blocking agents: four case reports

    Ann Rheum Dis

    (2004)
  • D. Baeten et al.

    Systematic safety follow-up in a cohort of 107 patients with spondyloarthropathy treated with infliximab: a new perspective on the role of host defense in the pathogenesis of the disease?

    Ann Rheum Dis

    (2003)
  • M. Verea et al.

    Psoriasiform eruption induced by infliximab

    Ann Pharmacother

    (2004)
  • M. Flendrie et al.

    Dermatological conditions during TNF-alpha blocking therapy in patients with rheumatoid arthritis: a prospective study

    Arthritis Res Ther

    (2005)
  • M. Thurber et al.

    Pustular psoriasis induced by infliximab

    J Drugs Dermatol

    (2004)
  • O. Dereure et al.

    Psoriatic lesions induced by ant tumor necrosis factor alpha treatment: two cases

    Br J Dermatol

    (2004)
  • P.P. Sifkakis et al.

    Psoriasis induced by anti-tumor necrosis factor therapy: a paradoxical adverse reaction

    Arthritis Rheum

    (2005)
  • L. Peramiquel et al.

    Onset of flexural psoriasis during infliximab treatment for Crohn’s Disease

    Clin Exp Derm

    (2005)
  • G. Michaelsson et al.

    Infliximab can precipitate as well as worsen palmoplantar pustulosis: possible linkage to the expression of tumor necrosis factor alpha in the normal palmar eccrine sweat duct?

    Br J Dermatol

    (2005)

    • Cited by (0)

    View full text
    Copyright © 2008 Elsevier Inc. All rights reserved.