Characteristics of Skin Lesions Associated With Anti–Tumor Necrosis Factor Therapy in Patients With Inflammatory Bowel Disease

Cleynen, Isabelle; Moerkercke, Wouter Van; Billiet, Thomas; Vandecandelaere, Pieter; Casteele, Niels Vande; Breynaert, Christine; Ballet, Vera; Ferrante, Marc; Noman, Maja; Assche, Gert Van; Rutgeerts, Paul; Gils, Ann; Segaert, Siegfried; Vermeire, Séverine

doi:10.7326/m15-0729

Cited by 121 publications

(117 citation statements)

References 42 publications

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“…The topical treatment of these psoriasiform lesions was, as expected, identical to the approach to classical psoriasis (betamethasone + calcipotriol). Recent studies suggest that, in these patients, contrarily to psoriasis, methicillin‐sensitive Staphylococcus aureus (MSSA) may play a pathogenic role, being particularly present in exudative, oozing lesions of the scalp and folds . In these cases, the use of topical (fusidic acid, usually in combination with a glucocorticoid) or systemic (doxycycline, flucloxacillin, and amoxicillin/clavulanic acid) antibiotics with activity against MSSA is recommended.…”

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%

“…Nail lesions are rare. Biopsies show irregular acanthosis, focal parakeratosis, and crust/scale formation …”

Section: Introductionmentioning

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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“…Third, side effects are common. Up to 29% of patients on anti-TNF therapy were found to have developed skin lesions in a recent retrospective study, including eczema in over 50% of cases 17. These may be delayed (median: 1.9 years from initiation) and can cause troublesome pain, pruritus and disfigurement.…”

Section: Resultsmentioning

confidence: 99%

Tacrolimus therapy in moderate to subacute ulcerative proctocolitis: a large single-centre cohort study

Saifuddin

Harris

2017

Frontline Gastroenterol

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“…A retrospective analysis found 29.4% (203/690) of Crohn’s patients who began tumor necrosis factor alpha-antagonist therapy developed various skin lesions [7]. Psoriasis composes 22.9% (8/35) of anti-tumor necrosis factor alpha-related cutaneous reactions with a prevalence of 1.5–5% in these patients [1, 8].…”

Section: Discussionmentioning

confidence: 99%

Severe Infliximab-Induced Alopecia and Scalp Psoriasis in a Woman with Crohn’s Disease: Dramatic Improvement after Drug Discontinuation and Treatment with Adjuvant Systemic and Topical Therapies

Udkoff

Cohen

2016

Dermatol Ther (Heidelb)

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Scalp psoriasis with alopecia is a rare cutaneous reaction to tumor necrosis factor alpha antagonists. This reaction often reverses with discontinuation of the offending drug and initiation of topical treatments; however, irreversible hair loss may occur if a scarring alopecia develops. We describe a woman with Crohn’s disease who developed scalp psoriasis and alopecia secondary to infliximab. She had a remarkable recovery after discontinuation of infliximab and treatment with oral minocycline and topical therapy: mineral oil under occlusion, betamethasone lotion, and sequential coal tar, salicylic acid, and ketoconazole shampoos each day. The patient’s alopecia completely resolved within 4 months of initiating this treatment regimen. In summary, early diagnosis of alopecia secondary to tumor necrosis factor alpha antagonist therapy is crucial in preventing diffuse alopecia and scalp psoriasis. In addition to discontinuing the offending agent, initiating aggressive adjuvant treatment with an oral antibiotic, topical therapies, or both, should be considered to reverse tumor necrosis factor alpha antagonist-induced alopecia and/or scalp psoriasis.

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Characteristics of Skin Lesions Associated With Anti–Tumor Necrosis Factor Therapy in Patients With Inflammatory Bowel Disease

Abstract: Research Foundation Flanders (FWO), Belgium; Geconcerteerde Onderzoekacties of KU Leuven; and Janssen Biologics.

Cited by 121 publications

References 42 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

Tacrolimus therapy in moderate to subacute ulcerative proctocolitis: a large single-centre cohort study

Severe Infliximab-Induced Alopecia and Scalp Psoriasis in a Woman with Crohn’s Disease: Dramatic Improvement after Drug Discontinuation and Treatment with Adjuvant Systemic and Topical Therapies

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