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

Abstract

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.

Paradoxical and bimodal immune‐mediated dermatological side effects of TNF‐α inhibitors: A comprehensive review

“…Over time, other reports of PAEs were published that were not limited to the skin but were related to organs outside the skin, including a case of IBD after treatment for ankylosing spondylitis reported in 2007 7 . About 25% of adverse reactions were dermatological reactions such as alopecia, erythema nodosum, immune bullous disorders, lichen planus, lichenoid drug reactions, erythema multiforme, Stevens Johnson, toxic epidermolysis necrolysis, vitiligo, neutrophilic dermatosis, and eosinophilic dermatosis 8 . This shows the great importance of dermatological events caused by TNF‐α inhibitors.…”

“…7 About 25% of adverse reactions were dermatological reactions such as alopecia, erythema nodosum, immune bullous disorders, lichen planus, lichenoid drug reactions, erythema multiforme, Stevens Johnson, toxic epidermolysis necrolysis, vitiligo, neutrophilic dermatosis, and eosinophilic dermatosis. 8 This shows the great importance of dermatological events caused by TNF-α inhibitors.…”