The Enigmatic Development of Psoriasis and Psoriasiform Lesions During Anti-TNF Therapy: A Review
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)
Monoclonal antibodies in the treatment of rheumatoid arthritis: toward a therapeutic revolution
C R Biol
(2006)- et al.
Staphylococcal toxins in patients with psoriasis, atopic dermatitis and erythroderma and in healthy control subjects
J Am Acad Dermatol
(2005) - et al.
Evidence for the involvement of bacterial superantigens in psoriasis, atopic dermatitis and Kawasaki syndrome
FEMS Microbiol Lett
(2000) - et al.
Autoimmunity through cytokine-induced dendritic cell activation
Immunity
(2004) - et al.
Defining upstream elements of psoriasis pathogenesis: an emerging role for interpheron alpha
J Invest Dermatol
(2005) Psoriatic arthritis update
Bull Hosp Jt Dis
(2006)- et al.
Treatment of inflammatory dermatoses by tumor necrosis factor antagonists
J Eur Acad Dermatol Venereol
(2006) - et al.
Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials
JAMA
(2006) - et al.
Cutaneous adverse events of biological therapy for psoriasis: review of the literature
Dermatology
(2005) - et al.
Unexpected onset of psoriasis during infliximab treatment: comment on the article by Beuthien et al
Arthritis Rheum
(2005)
The appearance of pustular psoriasis during antitumor necrosis factor therapy
J Clin Rheumatol
Skin reaction to adalimumab
Arthritis Rheum
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
Unexpected new onset or exacerbation of psoriasis in treatment of active ankylosing spondylitis with TNF-alpha blocking agents: four case reports
Ann Rheum Dis
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
Psoriasiform eruption induced by infliximab
Ann Pharmacother
Dermatological conditions during TNF-alpha blocking therapy in patients with rheumatoid arthritis: a prospective study
Arthritis Res Ther
Pustular psoriasis induced by infliximab
J Drugs Dermatol
Psoriatic lesions induced by ant tumor necrosis factor alpha treatment: two cases
Br J Dermatol
Psoriasis induced by anti-tumor necrosis factor therapy: a paradoxical adverse reaction
Arthritis Rheum
Onset of flexural psoriasis during infliximab treatment for Crohn’s Disease
Clin Exp Derm
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
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