Noninfectious skin lesions in Crohn's disease patients treated with ustekinumab: a multicenter observational
Gauthier Piga1, Aurélien Amiot2, Joelle Bonnet3
1Department of Gastroenterology, University Claude Bernard Lyon 1, Hospices Civils de Lyon, CHU Lyon-Sud, University Lyon1 and INSERM U1111, CIRI, Lyon, France.
Background & Aims:
Unlike antitumor necrosis factor (anti-TNF)-induced cutaneous adverse events, skin lesions occurring during ustekinumab therapy are uncommon and poorly characterized. We aimed to describe their clinical features, management, and outcomes in patients with Crohn's disease (CD).
Methods:
We conducted a retrospective multicenter study across 7 Groupe d'Études Thérapeutiques des Affections Inflammatoires Digestives centers between June 2015 and December 2024. Adult CD patients who developed significant noninfectious skin lesions during ustekinumab treatment requiring dermatological assessment were included. Clinical characteristics, dermatological diagnoses, management, and outcomes were collected.
Results:
Thirty-two patients (21 women; median age 38 years) developed noninfectious skin lesions. Considering the 740 patients exposed to ustekinumab in our cohort during the study period, the estimated prevalence of such lesions was 4.3% among ustekinumab-exposed patients. A history of atopy or psoriasis was present in 40% of patients, and 65% had previously experienced anti-TNF-induced immune-mediated skin lesions. At lesion onset, 59% had active CD. Psoriasiform (40%) and eczematous (31%) eruptions were most common, followed by acneiform lesions (25%) and 1 case of cutaneous vasculitis. Lesions predominantly involved the face (43%) and trunk (40%). Topical treatments were prescribed in 81% of patients, resulting in improvement in 70% of eczematous, 50% of psoriasiform, and 37% of acneiform lesions. Ustekinumab was discontinued in 8 patients (25%). Prior anti-TNF-induced immune-mediated skin lesions were associated with an increased risk of psoriasiform eruptions under ustekinumab (OR 12.0, 95% CI, 1.3-112.7; P = .03).
Conclusions:
Skin lesions requiring dermatological assessment occurred during ustekinumab treatment and displayed heterogeneous clinical phenotypes. A history of anti-TNF-induced immune-mediated skin reactions may identify patients at increased risk, particularly for psoriasiform eruptions.
Related Concept Videos
01:30Inflammatory Bowel Disease II: Crohn's Disease
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by transmural...
01:25Inflammatory Bowel Disease III: Crohn's Disease
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
01:20Inflammatory Bowel Disease IV: Clinical Manifestations
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...