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Published on: October 12, 2012

Broad range of adverse cutaneous eruptions in patients on TNF-alpha antagonists

Elena B Hawryluk1, Katy R Linskey, Lyn M Duncan

  • 1Department of Dermatology, Harvard Medical School, Boston, MA, USA.

Journal of Cutaneous Pathology
|April 21, 2012
PubMed

Insights

Anti-tumor necrosis factor (TNF)-alpha therapies can cause diverse skin eruptions, including rare conditions like neutrophilic eccrine hidradenitis. These adverse skin reactions often resolve with treatment adjustments or discontinuation of TNF-alpha inhibitors.

Area of Science:

  • Dermatology
  • Immunology
  • Rheumatology

Background:

  • Biologic therapies targeting tumor necrosis factor (TNF)-alpha are crucial for managing autoimmune diseases.
  • Understanding the full spectrum of adverse effects associated with these therapies is essential for patient care.

Observation:

  • A series of adverse skin eruptions were observed in six patients undergoing anti-TNF-alpha therapy (infliximab, adalimumab, etanercept).
  • Skin biopsies revealed diverse diagnoses including pustular folliculitis, psoriasis, interface dermatitis, neutrophilic eccrine hidradenitis, Sweet's syndrome, lupus, vasculitis, and palmoplantar pustulosis.
  • Notably, neutrophilic eccrine hidradenitis-like and Sweet's-like hypersensitivity eruptions represent novel findings associated with anti-TNF-alpha agents.

Findings:

  • All reported cutaneous eruptions showed improvement or resolution with modifications in anti-TNF-alpha therapy, such as switching agents, discontinuation, or adjunctive steroid treatment.
  • A clear temporal relationship existed between the onset of skin eruptions and the initiation of anti-TNF-alpha therapy, with remission upon withdrawal or suppression.
  • The study highlights a broad range of potential cutaneous adverse reactions to TNF-alpha inhibitors.

Implications:

  • The diverse cutaneous adverse reactions associated with TNF-alpha inhibitors necessitate their consideration in the differential diagnosis of skin conditions in patients receiving these treatments.
  • Further research is needed to elucidate the mechanisms underlying these varied dermatologic manifestations.
  • Clinicians should be vigilant for and prepared to manage a wide array of skin issues in patients on anti-TNF-alpha therapy.

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