[Therapeutic application of TNF-alpha inhibitors infliximab and etanercept in inflammatory skin disorders].
BACKGROUND
The treatment of inflammatory skin diseases is at present often empirical as causal therapeutic approaches are not available because of incomplete knowledge of the immune pathogenesis. The current therapeutic approaches can induce remission, but often produce undesirable side effects. On the basis of experience gained in cytokine modulation therapy of chronic inflammatory diseases such as rheumatoid arthritis and psoriasis, the use of TNF-alpha inhibitors could represent a further, more specific and effective therapeutic option for other selected inflammatory skin diseases.


METHODS
The current status of the therapeutic effect of anti-TNF-alpha blockers is discussed based on our own observations and a review of the current literature. Potential undesirable side effects and possible contraindications for this therapy are also considered.


CONCLUSIONS
Based on the recent findings, the use of TNF-alpha blockers seems to be promising in the treatment of therapy-resistant inflammatory dermatoses. At present, guidelines for indications and contraindications for anti-TNF-alpha treatment of inflammatory skin disorders do not exist. Such guidelines are necessary to improve the efficacy of anticytokine treatment and to reduce side effects.
Jacobi
Arnd
A
Dermatologische Klinik mit Poliklinik der Universität Erlangen-Nürnberg.
Manger
Bernhard
B
Schuler
Gerold
G
Hertl
Michael
M
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003872:Dermatitis / Q000188:drug therapy*; D003879:Dermatologic Agents / Q000627:therapeutic use; D000068800:Etanercept; D019317:Evidence-Based Medicine; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D000069285:Infliximab; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068800:Etanercept