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Anti-tumor necrosis factor-alpha-induced psoriasis
Ismail Sari1, Servet Akar, Merih Birlik
1Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey.
The Journal of Rheumatology
|July 6, 2006
Summary
Tumor necrosis factor-alpha (TNF-alpha) inhibitors like etanercept can trigger new-onset psoriasis or worsen existing cases. Psoriatic lesions resolved upon stopping the drug, indicating a direct link.
Area of Science:
- Rheumatology
- Dermatology
- Immunology
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease.
- Tumor necrosis factor-alpha (TNF-alpha) inhibitors are used to treat RA.
- Psoriasis is a chronic inflammatory skin condition.
Observation:
- A patient with RA developed psoriasis during etanercept treatment.
- Psoriatic lesions resolved after discontinuing etanercept.
- Psoriasis recurred upon rechallenge with etanercept.
- Switching to infliximab did not cause adverse skin reactions.
Findings:
- A Medline search identified 11 reports of 32 patients developing psoriasis or psoriasiform eruptions during TNF-alpha inhibitor therapy.
- All TNF-alpha blocking agents have been reported to induce or exacerbate psoriasis.
- Skin changes associated with TNF-alpha inhibitors can be severe.
Implications:
- TNF-alpha inhibitors may induce or exacerbate psoriasis in susceptible individuals.
- Discontinuation or switching of TNF-alpha inhibitors may be necessary for managing drug-induced psoriasis.
- Further research is needed to understand the mechanism of TNF-alpha inhibitor-induced psoriasis.