Psoriasiform Skin Lesions Are Caused by Anti-TNF Agents Used for the Treatment of Inflammatory Bowel Disease

• Published in: Digestive diseases and sciences 2015-11, Vol.60 (11), p.3424-3430
• Main Authors: George, Lauren A., Gadani, Akash, Cross, Raymond K., Jambaulikar, Guruprasad, Ghazi, Leyla J.
• Format: Article
• Language: English
• Subjects: Adalimumab; Adolescent; Adult; Analysis; Anti-Inflammatory Agents - adverse effects; Biochemistry; Biological Products - adverse effects; Care and treatment; Chi-Square Distribution; Colitis, Ulcerative - diagnosis; Colitis, Ulcerative - drug therapy; Colitis, Ulcerative - immunology; Crohn Disease - diagnosis; Crohn Disease - drug therapy; Crohn Disease - immunology; Drug Eruptions - diagnosis; Drug Eruptions - etiology; Drug Eruptions - therapy; Female; Gastroenterology; Hepatology; Humans; Inflammatory bowel disease; Logistic Models; Male; Medical colleges; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Multivariate Analysis; Odds Ratio; Oncology; Original Article; Patient education; Pneumoviridae; Psoriasis - chemically induced; Psoriasis - diagnosis; Psoriasis - therapy; Retrospective Studies; Risk Factors; Skin; Tertiary Care Centers; Time Factors; Transplant Surgery; Tumor necrosis factor; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Ulcerative colitis; Young Adult
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-015-3763-0

Background Tumor necrosis factor (TNF) antagonists used for the treatment of inflammatory bowel disease (IBD) have been associated with the development of psoriasiform skin lesions. We assessed the demographic and clinical characteristics associated with and outcomes of patients with anti-TNF-induced psoriasiform lesions. Methods Patients with Crohn’s disease (CD) and ulcerative colitis (UC) receiving treatment with anti-TNF therapy (infliximab, adalimumab, or certolizumab pegol) at a tertiary referral center were identified using an IRB-approved clinical data repository. Patients that developed psoriasiform skin lesions after initiation of anti-TNF therapy were included as cases. A group of anti-TNF-treated patients without drug-related psoriasiform lesions were identified as controls. The association between demographic and clinical variables and psoriasiform lesions was assessed using Chi-square analyses and multivariable logistic regression. Results Five hundred twenty-one patients with IBD undergoing treatment with anti-TNF therapy were identified; of these, 18 (3.5 %) had psoriasiform lesions (16 CD and 2 UC). Seventy-two patients were identified as controls. Lesions developed a mean of 58 weeks (range 4–240 weeks) after starting anti-TNF therapy. The majority of patients were female and Caucasian (63 and 78 %, respectively). Thirty-nine percent of patients had upper tract disease location. Forty-five patients (50 %) were current or former smokers. Location of psoriasiform lesions included palmo-plantar (53 %), trunk (47 %), and scalp (53 %), with 88 % reporting involvement of ≥2 locations. Treatment of psoriasiform lesions was instituted with topical therapy in eight patients and systemic therapy (± phototherapy) in five patients. Discontinuation of anti-TNF therapy was recommended in nine patients (50 %); of those, three were retreated with a second anti-TNF agent and all had recurrence of psoriasiform lesions. When adjusted for multiple variables, upper GI tract disease was significantly associated with psoriasiform lesions. Conclusions Anti-TNF-induced psoriasiform lesions developed in 3.5 % of patients with IBD at a tertiary referral center. Similar to prior published studies, most patients were female, had involvement of the palmo-plantar and scalp regions, and did not have severe IBD activity. The presence of upper tract disease was associated with the development of psoriasiform lesions. Skin lesions led to discontinuation of anti-TNF therapy