CASE REPORTS - Psoriasis induced by anti-TNF therapy: a paradoxical adverse reaction

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Arthritis Rheum. 2005 Aug;52(8):2513-8.

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

adverse reaction.

Sfikakis PP, Iliopoulos A, Elezoglou A, Kittas C, Stratigos A.

Athens University Medical School, Greece. psfikakis@...

Administration of anti-tumor necrosis factor (anti-TNF) agents is beneficial

in a variety of chronic inflammatory conditions, including psoriasis. We

describe 5 patients in whom psoriasiform skin lesions developed 6-9 months

after the initiation of anti-TNF therapy for longstanding, seropositive

rheumatoid arthritis (etanercept or adalimumab), typical ankylosing

spondylitis (infliximab), and Adamantiades-Behcet's disease (infliximab). In

all 5 patients, the underlying disease had responded well to anti-TNF

therapy. Four patients developed a striking pustular eruption on the palms

and/or soles accompanied by plaque-type psoriasis at other skin sites, while

1 patient developed thick erythematous scaly plaques localized to the scalp.

In 3 patients there was nail involvement with onycholysis, yellow

discoloration, and subungual keratosis. Histologic findings from skin

biopsies were consistent with psoriasis. None of these patients had a

personal or family history of psoriasis. In all patients, skin lesions

subsided either with topical treatment alone, or after discontinuation of

the responsible anti-TNF agent. The interpretation of this paradoxical side

effect of anti-TNF therapy remains unclear but may relate to altered

immunity induced by the inhibition of TNF activity in predisposed

individuals.

PMID: 16052599

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6052599 & dopt=Abstract

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