title: Lichen planus-like eruptions: an emerging side effect of tumor necrosis factor-alpha antagonists.
abstract: As tumor necrosis factor (TNF)-alpha inhibitors gain wider use in clinical practice, it is becoming increasingly evident that these potent immunosuppressants can also induce inflammatory reactions. We present two cases of lichen planus-like eruptions after infliximab and adalimumab therapy for psoriasis, and review the literature on this phenomenon. Eleven cases of lichen planus or lichenoid drug eruptions have been previously reported in patients taking TNF-alpha inhibitors, in addition to several cases of psoriasiform eruptions with a lichenoid histology. Because TNF-alpha has been implicated in the pathogenesis of lichen planus, induction of lichenoid reactions by TNF-alpha inhibition is somewhat unexpected. We consider potential immunologic mechanisms, and suggest that TNF-alpha inhibition may precipitate lichenoid reactions through disruption of a delicate balance between TNF-alpha and interferon-alpha in susceptible patients.
authors.affiliation: Department of Dermatology, Tufts Medical Center, 800 Washington St. 114, Boston, MA 02111, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Asarch
authors.forename: Alice B
authors.initials: AB
authors.lastname: Gottlieb
authors.forename: Jin
authors.initials: J
authors.lastname: Lee
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Masterpol
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Scheinman
authors.forename: Miguel J
authors.initials: MJ
authors.lastname: Stadecker
authors.forename: Elena M
authors.initials: EM
authors.lastname: Massarotti
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Bush
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D003875:Drug Eruptions / Q000276:immunology; D005260:Female; D006801:Humans; D000069285:Infliximab; D016898:Interferon-alpha / Q000276:immunology; D008010:Lichen Planus / Q000139:chemically induced; D017512:Lichenoid Eruptions / Q000139:chemically induced* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D016898:Interferon-alpha; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab