Anti-Tumor Necrosis Factor-α-Induced Dermatological Complications in a Large Cohort of Inflammatory Bowel Disease Patients

Andrade, Patrícia; Lopes, Susana; Gaspar, Rui; Nunes, Ana V. M.; Magina, Sofia; Macedo, Guilherme

doi:10.1007/s10620-018-4921-y

Cited by 35 publications

(51 citation statements)

References 34 publications

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“…For this reason, it is not consensual if another anti‐TNF‐ α should be attempted or a different therapeutic class should be considered. A wide range of recurrence rates after a second anti‐TNF‐ α agent was observed in different studies . In spite of an important risk of recurrence, two of the included studies recommended a switch to a second anti‐TNF‐ α drug.…”

Section: Discussionmentioning

confidence: 99%

“…A wide range of recurrence rates after a second anti-TNF-a agent was observed in different studies. 8,[15][16][17][20][21][22][23][24] In spite of an important risk of recurrence, two of the included studies 16,21 recommended a switch to a second anti-TNF-a drug. In our opinion, this is worth attempting, as other therapeutic options for IBD are lacking.…”

Section: Discussionmentioning

confidence: 99%

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Clinical management of Anti‐TNF‐alpha‐induced psoriasis or psoriasiform lesions in inflammatory bowel disease patients: a systematic review

Melo

Magina

2018

Int J Dermatology

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Tumor necrosis factor alpha inhibitors (anti-TNF-α) completely revolutionized the treatment of inflammatory bowel disease (IBD). However, anti-TNF-α-induced cutaneous side effects have been increasingly reported in the literature. Particularly, psoriasis and the recently recognized psoriasiform lesions are of particular concern, as anti-TNF-α agents are also used in the treatment of psoriasis, seemingly reflecting an immunological paradox. The clinical management of these cutaneous lesions is particularly challenging, owing to the potential need of anti-TNF-α discontinuation and scarcity of other therapeutic options. Therefore, optimization of current topical and systemic therapies and incorporation of new therapeutic agents is of great interest. Our aim is to review data in the literature regarding the clinical management of these cutaneous lesions and provide a therapeutic algorithm, supported by our experience as a tertiary referral center for IBD. Although in older reports no distinction was made, anti-TNF-α-induced psoriasiform lesions are not only more prevalent but also bear notable differences from classical psoriasis, possibly reflecting a different nosological entity. Onset of lesions has been related to periods of IBD remission, as supported by low levels of fecal calprotectin. Psoriasiform lesions can be adequately managed either by topical (glucocorticoids, calcineurin inhibitors, and antibiotics) or systemic (phototherapy, acitretin, glucocorticoids, and antibiotics) therapies and/or switch to other anti-TNF-α agents. Data referring to patients who were able to continue on the same IBD therapy ranged from 30.7 to 100%, reinforcing the importance of an adequate control of these lesions. The recently approved ustekinumab offers another step in the management of anti-TNF-α-intolerant patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical management of Anti‐TNF‐alpha‐induced psoriasis or psoriasiform lesions in inflammatory bowel disease patients: a systematic review

Melo

Magina

2018

Int J Dermatology

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“…In previous studies, rheumatoid arthritis and Crohn's disease were found as the most common underlying illnesses (Joyau, Veyrac, Dixneuf, & Jolliet, ; Mazloom et al, ). Andrade et al conducted a retrospective observational study with 732 inflammatory bowel disease patients treated with anti‐TNF‐α agents and reported that the only treatment with adalimumab (OR = 8.894, p < .001) were independently associated with the development of psoriasiform lesions (Andrade et al, ). They also found that frequency of dermatological complications were as follow: infections (13.5%), psoriasiform lesions (5.3%), injection/infusion reactions (3.8%), skin cancer (0.5%), and miscellaneous (5.6%, 41/732), respectively.…”

Section: Discussionmentioning

confidence: 99%

Adalimumab‐induced scalp psoriasis with severe alopecia

Özkur

Altunay

Leblebıcı

et al. 2019

Dermatologic Therapy

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In recent years, with the increase usage of tumor necrosis factor (TNF) inhibitors, more side effects have revealed. The incidence of paradoxical psoriasis (psoriasis vulgaris, palmoplantar pustulosis, scalp psoriasis, or their combinations) ranges from 1 to 5%; however alopecia due to anti‐TNF‐α‐induced scalp psoriasis, rarely reported in the literature. We report a 37‐year‐old woman who developed palmoplantar pustulosis and scalp psoriasis with severe alopecia after 2 months of treatment with adalimumab for chronic plaque psoriasis. Biopsies from the palmar and scalp lesions showed psoriasiform changes. Adalimumab treatment was discontinued, and methotrexate was started (15 mg/weekly, subcutaneously) with topical adjuvant agents. A dramatic improvement was seen in both the skin and scalp with complete hair regrowth in 1 month. We conclude that, in anti‐TNF‐α‐induced scalp psoriasis, suspension of anti‐TNF‐α agent and systemic and topical treatments should be considered to avoid scarring alopecia.

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“…Most common were folliculitis in 38% of patients and abscesses in 31%. Psoriatic patients are likely to have less abscesses, since IBD diseases have specific extraintestinal manifestations and are also associated with hidradenitis suppurativa comorbidity which may be evaluated as folliculitis and abscesses [19].…”

Section: Mg Acute Hospitalization For Extensive Herpes Zoster In Dermentioning

confidence: 99%

Skin Adverse Reactions Related to TNF Alpha Inhibitors: Classification and Therapeutic Approach in Psoriatic Patients

Vorčáková¹,

Tatiana²,

Martinásková³

et al. 2019

Tailored Treatments in Psoriatic Patients

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Tumor necrosis factor alpha (TNF alpha) inhibitors are widely and effectively used for inflammatory and autoimmune diseases in rheumatology, gastroenterology, and dermatology. Adalimumab, etanercept, and infliximab are indicated for the treatment of patients with moderate to severe chronic plaque psoriasis. This target treatment is very effective and lead to control the most severe cases, which were formerly fatal. Biologic treatment is strictly monitored. These large molecules, even with the same mechanism of action in the form of inhibiting TNF alpha, may act differently, and they may have other adverse effects. Skin complications of anti-TNF alpha treatment include a wide range of manifestations which can be divided into four groups: infections, reactions directly associated with drug administration, immune-mediated skin reaction, and malignancy. This chapter describes currently available information regarding the occurrence of individual complications and defines possible therapeutic options in case of individual adverse reactions.

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Anti-Tumor Necrosis Factor-α-Induced Dermatological Complications in a Large Cohort of Inflammatory Bowel Disease Patients

Abstract: Dermatological manifestations occurred in almost one-third of our population. Infections were the most common complication, but anti-TNF-induced psoriasiform lesions were the most common cause for anti-TNF therapy definitive discontinuation.

Cited by 35 publications

References 34 publications

Clinical management of Anti‐TNF‐alpha‐induced psoriasis or psoriasiform lesions in inflammatory bowel disease patients: a systematic review

Clinical management of Anti‐TNF‐alpha‐induced psoriasis or psoriasiform lesions in inflammatory bowel disease patients: a systematic review

Adalimumab‐induced scalp psoriasis with severe alopecia

Skin Adverse Reactions Related to TNF Alpha Inhibitors: Classification and Therapeutic Approach in Psoriatic Patients

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