Severe skin lesions cause patients with inflammatory bowel disease to discontinue anti-tumor necrosis factor therapy.
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.
Rahier
Jean-François
JF
Department of Gastroenterology, Cliniques Universitaires UCL Mont Godinne, Yvoir, Belgium. jfrahier@gmail.com
Buche
Sébastien
S
Peyrin-Biroulet
Laurent
L
Bouhnik
Yoram
Y
Duclos
Bernard
B
Louis
Edouard
E
Papay
Pavol
P
Allez
Matthieu
M
Cosnes
Jacques
J
Cortot
Antoine
A
Laharie
David
D
Reimund
Jean-Marie
JM
Lémann
Marc
M
Delaporte
Emmanuel
E
Colombel
Jean-Frédéric
JF
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*
D007155:Immunologic Factors; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha