Khang Nguyen1, Ruth Ann Vleugels, Nicole F Velez, Joseph F Merola, Abrar A Qureshi. 1. From the *Department of Dermatology, †Division of Rheumatology, Allergy and Immunology, Department of Medicine, Channing Laboratory, and ‡Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
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.
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.
Authors: T Cabaleiro; R Prieto-Pérez; R Navarro; G Solano; M Román; D Ochoa; F Abad-Santos; E Daudén Journal: Pharmacogenomics J Date: 2015-07-21 Impact factor: 3.550
Authors: Jung Eun Seol; In Ho Park; Wonkyung Lee; Hyojin Kim; So Young Jung; Han Young Wang Journal: Ann Dermatol Date: 2016-07-26 Impact factor: 1.444