Tumor necrosis factor-α inhibitor-induced psoriasis: Systematic review of clinical features, histopathological findings, and management experience

• Published in: Journal of the American Academy of Dermatology Vol. 76; no. 2; pp. 334 - 341
• Main Authors: Brown, Gabrielle, Wang, Eva, Leon, Argentina, Huynh, Monica, Wehner, Mackenzie, Matro, Rebecca, Linos, Eleni, Liao, Wilson, Haemel, Anna
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2017
• Subjects: adalimumab; Adolescent; Adult; adverse event; Aged; Aged, 80 and over; certolizumab; Child; Dermatology; Drug Eruptions - diagnosis; Drug Eruptions - etiology; Drug Eruptions - therapy; etanercept; Female; golimumab; Humans; infliximab; Male; medication side effect; Middle Aged; psoriasis; Psoriasis - chemically induced; Psoriasis - diagnosis; Psoriasis - therapy; Tumor Necrosis Factor-alpha - antagonists & inhibitors; tumor necrosis factor-α inhibitor; tumor necrosis factor-α-induced psoriasis; Young Adult; medication side effect; CD; IL; etanercept; infliximab; AZA; adverse event; certolizumab; MeSH; tumor necrosis factor-α inhibitor; adalimumab; golimumab; UC; RA; IFN-α; MTX; AS; IL-23R; TH; TNF-α; tumor necrosis factor-α-induced psoriasis; psoriasis; ankylosing spondylitis; methotrexate; interleukin-23 receptor; interferon α; ulcerative colitis; interleukin; T helper; azathioprine; rheumatoid arthritis; medical subject headings; Crohn disease; tumor necrosis factor-α; T H
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2016.08.012

Tumor necrosis factor-α (TNF-α) inhibitors have been reported to induce new-onset psoriasis. To better define the demographic, clinical features, and treatment approach of TNF-α inhibitor-induced psoriasis. Systematic review of published cases of TNF-α inhibitor-induced psoriasis. We identified 88 articles with 216 cases of new-onset TNF-α inhibitor-induced psoriasis. The mean age at psoriasis onset was 38.5 years. The most common underlying diseases were Crohn disease (40.7%) and rheumatoid arthritis (37.0%). Patients underwent TNF-α therapy for an average of 14.0 months before psoriasis onset with 69.9% of patients experiencing onset within the first year. The majority of patients received skin-directed therapy, though patients who discontinued TNF therapy had the greatest resolution of symptoms (47.7%) compared with those who switched to a different TNF agent (36.7%) or continued therapy (32.9%). Retrospective review that relies on case reports and series. While TNF-α inhibitor cessation may result in resolution of induced psoriasis, lesions may persist. Decisions regarding treatment should be weighed against the treatability of TNF-α inhibitor-induced psoriasis, the severity of the background rheumatologic or gastrointestinal disease, and possible loss of efficacy with cessation followed by retreatment. Skin-directed therapy is a reasonable initial strategy except in severe cases.