| Abstract | Administration of anti-tumor necrosis factor (anti-TNF) agents is beneficial in a variety of chronic inflammatory conditions, including psoriasis. We describe 5 patients in whom psoriasiform skin lesions developed 6-9 months after the initiation of anti-TNF therapy for longstanding, seropositive rheumatoid arthritis (etanercept or adalimumab), typical ankylosing spondylitis (infliximab), and Adamantiades-Behçet's disease (infliximab). In all 5 patients, the underlying disease had responded well to anti-TNF therapy. Four patients developed a striking pustular eruption on the palms and/or soles accompanied by plaque-type psoriasis at other skin sites, while 1 patient developed thick erythematous scaly plaques localized to the scalp. In 3 patients there was nail involvement with onycholysis, yellow discoloration, and subungual keratosis. Histologic findings from skin biopsies were consistent with psoriasis. None of these patients had a personal or family history of psoriasis. In all patients, skin lesions subsided either with topical treatment alone, or after discontinuation of the responsible anti-TNF agent. The interpretation of this paradoxical side effect of anti-TNF therapy remains unclear but may relate to altered immunity induced by the inhibition of TNF activity in predisposed individuals. |
| Authors | P P Sfikakis, A Iliopoulos, A Elezoglou, C Kittas, A Stratigos
(Affiliation: Athens University Medical School, Greece. psfikakis at med.uoa.gr)
|
| Journal | Arthritis and rheumatism
(Arthritis Rheum)
Vol. 52
Issue 8
Pg. 2513-8
(Aug 2005)
ISSN: 0004-3591 United States |
| PMID | 16052599
(Publication Type: Case Reports, Journal Article)
|
| Chemical References |
- Antibodies, Monoclonal
- Immunoglobulin G
- Receptors, Tumor Necrosis Factor
- Tumor Necrosis Factor-alpha
- adalimumab
- TNFR-Fc fusion protein
|
| Topics |
- Adult
- Aged
- Antibodies, Monoclonal
(adverse effects, immunology)
- Arthritis, Rheumatoid
(drug therapy)
- Behcet Syndrome
(drug therapy)
- Female
- Humans
- Immunoglobulin G
(adverse effects, immunology)
- Male
- Middle Aged
- Psoriasis
(chemically induced, pathology)
- Receptors, Tumor Necrosis Factor
(immunology)
- Spondylitis, Ankylosing
(drug therapy)
- Tumor Necrosis Factor-alpha
(antagonists & inhibitors, immunology)
|
