Skin Reactions During Anti-TNFα Therapy for Pediatric Inflammatory Bowel Disease

Mälkönen, Tarja; Puustinen, Anne; Heiskanen, Kaarina; Merras‐Salmio, Laura; Mustonen, Harri; Sipponen, Taina; Kolho, Kaija‐Leena

doi:10.1097/mib.0000000000000088

Cited by 54 publications

(67 citation statements)

References 30 publications

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“…Th ese diff erences could be explained by the systematic enquiry for cutaneous lesions and referral to a dermatologist in our center. In a prospective study on pediatric IBD patients, an attentive and double-checked clinical examination by nurses and physicians revealed a skin lesions rate of 47.6% ( 23 ). Psoriasis more frequently aff ected women (69.5%) and patients with CD (88.1%) in our study: these results are comparable with previous data reviewed by Torres et al ( 24 ).…”

Section: Discussionsupporting

confidence: 93%

“…Th is cumulative incidence is similar to the one observed in another French retrospective study, which found a cumulative incidence of cutaneous events of 22% (207 patients on a total of 922) ( 22 ). A recent prospective study, carried on a pediatric population of IBD patients treated with IFX, found a higher incidence of cutaneous events in nearly 50% of patients, with 23.8% of them having severe lesions ( 23 ). Previous studies found that CD was signifi cantly associated with onset of cutaneous infections, which had never been demonstrated before.…”

Section: Discussionsupporting

confidence: 76%

“…Interestingly, IBD was in clinical remission in 88.1% of patients at time of psoriasis onset. Recently, in a pediatric population, most patients with skin reactions had a low degree of intestinal infl ammation based on fecal calprotectin levels ( 23 ). At time of onset of psoriasiform lesions, mean duration of anti-TNF therapy was 42.7 months for IFX (range=1-129) and 34.2 months for ADA (range=6.5-88.8).…”

Section: Discussionmentioning

confidence: 99%

“…In a recent 2-year prospective study performed on 84 pediatric patients with IBD, nearly half of them suff ered from skin lesions related to anti-TNF ( 23 ). No data are available on the cumulative incidence, the management, the outcome, and the prognostic factors of dermatological complications in a large cohort of adult CD and UC patients treated with anti-TNF agents ( 8,(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 94%

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Cumulative Incidence of, Risk Factors for, and Outcome of Dermatological Complications of Anti-TNF Therapy in Inflammatory Bowel Disease: A 14-Year Experience

Fréling

Baumann

Cuny

et al. 2015

American Journal of Gastroenterology

116

113

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Dermatological complications involve one of five patients treated with anti-TNF therapy after a 14-year follow-up. Association of cutaneous infections with higher anti-TNF dosing suggests a dose-dependent effect. Discontinuation of anti-TNF therapy due to dermatological complications is required in one out of five patients with psoriasiform lesions, but specific dermatological treatment allows to continue anti-TNF therapy in half of them.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

See 2 more Smart Citations

Cumulative Incidence of, Risk Factors for, and Outcome of Dermatological Complications of Anti-TNF Therapy in Inflammatory Bowel Disease: A 14-Year Experience

Fréling

Baumann

Cuny

et al. 2015

American Journal of Gastroenterology

116

113

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“…Similarly, anti-TNF agents, among the most effective treatments for psoriasis, occasionally cause psoriasis. [176][177][178][179] The particular hallmarks of anti-TNF induced psoriasis, more common in women than in men, is a distribution on palms, soles, and the scalp (fig 2). 180 A recent multicenter study of 7415 patients in Spain, treated for IBD with anti-TNF drugs, noted an incidence of psoriasis of 0.5% per patient year.…”

Section: Skin Lesionsmentioning

confidence: 99%

Update on anti-tumor necrosis factor agents and other new drugs for inflammatory bowel disease

Cohen

Sachar

2017

BMJ

115

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The treatment of inflammatory bowel disease (IBD)-ulcerative colitis (UC) and Crohn's disease (CD)-has evolved beyond surgery with the introduction of biologic agents, primarily antibodies against mediators of inflammation and cell attraction. Anti-tumor necrosis factor (TNF) agents have been the first line treatment for moderate to severe ulcerative colitis and Crohn's disease for more than 15 years. During that time much has been learnt about how best to use these agents. This review will assess the evidence on how to optimize the use of anti-TNF agents; when and how to start treatment; how to monitor treatment and when to de-escalate it; and the potential adverse effects of these drugs. New and emerging treatments such as anti-attractants, anti-interleukins, and Janus kinase (JAK) inhibitors will also be discussed.

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Paradoxical Psoriasiform Eruptions in Children Receiving Tumor Necrosis Factor α Inhibitors

et al. 2023

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ImportanceTumor necrosis factor α (TNF) inhibitor–induced psoriasiform eruption is well recognized in adults, but few reports document this paradoxical effect in children.ObjectiveTo characterize the clinical features and the clinical time course of TNF inhibitor–induced psoriasiform eruptions in children.Design, Setting, and ParticipantsA multicenter retrospective case series of children younger than 18 years seen between January 1, 2000, and December 31, 2016, who developed a new-onset psoriasiform eruption while taking a TNF inhibitor for a nondermatologic disorder. Participating sites were members of the Pediatric Dermatology Research Alliance. Data were entered into a Research Electronic Data Capture database at the Mayo Clinic (ie, the coordinating center).ResultsPsoriasiform eruptions were identified in 103 TNF inhibitor–treated patients (median age, 13.8 years [IQR, 11.7-16.4 years]; 52 female patients [50%]; 57 White patients [55%]), with 67 patients (65%) treated with infliximab, 35 (34%) with adalimumab, and 1 (1%) with certolizumab pegol. Most patients had no personal history (101 [98%]) or family history of psoriasis (60 patients [58%]). Inflammatory bowel disease was the most common indication for treatment with TNF inhibitor (94 patients [91%]). The primary extracutaneous disease was under control in 95 patients (92%) who developed the eruption. Most patients (n = 85 [83%]) developed psoriasiform eruptions at multiple anatomic sites, with scalp involvement being most common (65 patients [63%]). Skin disease developed at a median of 14.5 months (IQR, 9-24 months) after TNF inhibitor initiation. To treat the psoriasiform eruption, topical steroidal and nonsteroidal medication was prescribed for all patients. Systemic therapy was added for 30 patients (29%): methotrexate for 24 patients (23%), oral corticosteroids for 8 patients (8%), and azathioprine for 1 patient (1%). For 26 patients (25%), suboptimal effectiveness with topical medications alone prompted discontinuation of the initial TNF inhibitor and a change to a second-line TNF inhibitor with cutaneous improvement in 23 patients (88%) by a median of 3 months (IQR, 2-4 months). Eight patients (31%) who started a second-line TNF inhibitor developed a subsequent TNF inhibitor–induced psoriasiform eruption at a median of 6 months (IQR, 4-8 months). Persistent skin disease in 18 patients (17%) prompted discontinuation of all TNF inhibitors; 11 patients changed to a non-TNF inhibitor systemic therapy, and 7 discontinued all systemic therapy.Conclusions and RelevanceIn this case series, paradoxical TNF inhibitor–induced psoriasiform eruptions were seen in children treated with TNF inhibitors for any indication, and there appears to be a class effect among the varying TNF inhibitors. The majority of these children were able to continue TNF inhibitor therapy with adequate skin-directed and other adjuvant therapies.

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Skin Reactions During Anti-TNFα Therapy for Pediatric Inflammatory Bowel Disease

Abstract: Skin reactions are common during maintenance therapy with infliximab in pediatric patients. For most patients, skin reactions seem to correlate with a low level of intestinal inflammation. Although potentially harsh, skin lesions mostly allow continuation of infliximab.

Cited by 54 publications

References 30 publications

Cumulative Incidence of, Risk Factors for, and Outcome of Dermatological Complications of Anti-TNF Therapy in Inflammatory Bowel Disease: A 14-Year Experience

Cumulative Incidence of, Risk Factors for, and Outcome of Dermatological Complications of Anti-TNF Therapy in Inflammatory Bowel Disease: A 14-Year Experience

Update on anti-tumor necrosis factor agents and other new drugs for inflammatory bowel disease

Paradoxical Psoriasiform Eruptions in Children Receiving Tumor Necrosis Factor α Inhibitors

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