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Medline ® Abstract for Reference 29

of 'Guttate psoriasis'

Induction of psoriasis with anti-TNF agents in patients with inflammatory bowel disease: a report of 21 cases.
Guerra I, Algaba A, Pérez-Calle JL, Chaparro M, Marín-Jiménez I, García-Castellanos R, González-Lama Y, López-Sanromán A, Manceñido N, Martínez-Montiel P, Quintanilla E, Taxonera C, Villafruela M, Romero-MatéA, López-Serrano P, Gisbert JP, Bermejo F
J Crohns Colitis. 2012;6(5):518. Epub 2011 Nov 13.
AIM: Anti-tumor necrosis factor (TNF)-alpha agents are widely used for the treatment of both inflammatory bowel disease (IBD) and psoriasis. Psoriatic skin lesions induced by anti-TNF have been described in patients with IBD. We report a case series of psoriasis induced by anti-TNF agents in IBD patients.
METHODS: Systematic analysis of cases of psoriasis induced by anti-TNF in an IBD patient cohort in tertiary hospitals of Madrid.
RESULTS: A total of 21 of 1294 patients with IBD treated with anti-TNF-alpha agents developed drug-induced psoriasis (cumulative incidence 1.62%; 95% CI 1.06%-2.47%): 14 patients with infliximab and 7 with adalimumab; seventeen with Crohn's disease, 4 with ulcerative colitis. The onset of skin lesions varied in a wide range of time (after a mean 13±8 doses). The most frequent site of skin lesions was the limbs (62%)followed by the trunk (48%) and the scalp (43%). The psoriasis phenotypes were plaque psoriasis (57%), scalp (14%), palmoplantar pustulosis (14%), pustular generalized psoriasis (5%), guttate (5%) and inverse (5%). Four patients interrupted the anti-TNF treatment, and that led to the complete regression of lesions in 1 of them. The other 17 patients were maintained on anti-TNF therapy and managed with topical steroids.
CONCLUSION: Psoriatic lesions can be induced by anti-TNF drugs. Plaque psoriasis on the extremities and trunk were the most frequent presentations in our series. Topical steroid treatment is effective in most patients. Anti-TNF discontinuance may be reserved for patients with severe psoriasis or patients without response to topical therapy.
Digestive Diseases Department, Hospital de Fuenlabrada, Spain. ivan.guerra@salud.madrid.org