title: Severe skin lesions cause patients with inflammatory bowel disease to discontinue anti-tumor necrosis factor therapy.
abstract: OBJECTIVE
  Psoriasiform and eczematiform lesions are associated with anti-tumor necrosis factor (TNF)-α therapies. We assessed clinical characteristics, risk factors, and outcomes of skin disease in patients with inflammatory bowel diseases that presented with psoriasiform and eczematiform lesions induced by anti-TNF-α agents.
  
  
  METHODS
  We studied 85 patients (69 with Crohn's disease, 15 with ulcerative colitis, and 1 with indeterminate colitis; 62 women) with inflammatory skin lesions (62 psoriasiform and 23 eczematiform lesions).
  
  
  RESULTS
  Twenty-four patients had a history of inflammatory skin lesions and 15 had a familial history of inflammatory skin disease. Locations of eczematiform lesions varied whereas scalp and flexural varieties were mostly psoriasiform. Skin lesions emerged but inflammatory bowel disease was quiescent in 69 patients following treatment with any type of anti-TNF-α agent (60 with infliximab, 20 with adalimumab, and 5 with certolizumab). Topical therapy resulted in partial or total remission in 41 patients. Patients with psoriasiform lesions that were resistant to topical therapy and that changed anti-TNF-α therapies once or twice developed recurring lesions. Overall, uncontrolled skin lesions caused 29 patients to stop taking TNF-α inhibitors.
  
  
  CONCLUSIONS
  Inflammatory skin lesions following therapy with TNF-α inhibitors occurred most frequently among women and patients with a personal or familial history of inflammatory skin disease; lesions did not correlate with intestinal disease activity. Recurring and intense skin lesions caused 34% of patients in this study to discontinue use of anti-TNF-α agents.
authors: Department of Gastroenterology, Cliniques Universitaires UCL Mont Godinne, Yvoir, Belgium. jfrahier@gmail.com
authors: Jean-François
authors: JF
authors: Rahier
authors: Sébastien
authors: S
authors: Buche
authors: Laurent
authors: L
authors: Peyrin-Biroulet
authors: Yoram
authors: Y
authors: Bouhnik
authors: Bernard
authors: B
authors: Duclos
authors: Edouard
authors: E
authors: Louis
authors: Pavol
authors: P
authors: Papay
authors: Matthieu
authors: M
authors: Allez
authors: Jacques
authors: J
authors: Cosnes
authors: Antoine
authors: A
authors: Cortot
authors: David
authors: D
authors: Laharie
authors: Jean-Marie
authors: JM
authors: Reimund
authors: Marc
authors: M
authors: Lémann
authors: Emmanuel
authors: E
authors: Delaporte
authors: Jean-Frédéric
authors: JF
authors: Colombel
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects* / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D011565:Psoriasis / Q000139:chemically induced* / Q000473:pathology; D012307:Risk Factors; D017443:Skin Diseases, Eczematous / Q000139:chemically induced* / Q000473:pathology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D028761:Withholding Treatment / Q000706:statistics & numerical data*
chemical_list: D007155:Immunologic Factors; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha