title: Tumor necrosis factor-alpha antagonist therapy-induced psoriasis in Turkey: analysis of 514 patients.
abstract: OBJECTIVE
  New adverse events are being reported with the increased use of anti-tumor necrosis factor (TNF) α therapy. We studied cases of anti-TNFα-induced psoriasis observed in our pool of 514 patients receiving anti-TNFα treatment in Turkey.
  
  
  METHODS
  Three rheumatoid arthritis patients and 3 ankylosing spondylitis patients with anti-TNFα-induced psoriasis were included in the study. All patients were examined by a dermatologist, and 3 patients underwent skin biopsy.
  
  
  RESULTS
  None of the 6 patients had preexisting psoriasis or a familial history of psoriasis. The earliest and latest occurrences of psoriatic lesions were at the 6th week and 44th month of anti-TNFα therapy, respectively. Psoriasis was severe and refractory in two patients (requiring systemic treatment), while it presented as mild in four patients. Anti-TNFα therapy was totally withdrawn in case 1. In case 2, the treatment was halted for 3 months then switched to another TNFα blocker, and case 3 was switched to another anti-TNFα treatment. The treatment was sustained in the other 3 patients (cases 4, 5, and 6).
  
  
  CONCLUSIONS
  TNFα blockers are very effective agents in the treatment of psoriasis, but it is interesting that the same molecules can, paradoxically, induce psoriasis. The occurrence of anti-TNFα-induced psoriasis in six out of 514 patients suggests that the incidence of this adverse reaction is, in fact, as not low as presumed in the literature. In some cases, a severe course of psoriasis may limit the use of these agents.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Uludag Medical Faculty, Uludag University, Bursa, Turkey. edizinci@hotmail.com
authors.forename: Ediz
authors.initials: E
authors.lastname: Dalkilic
authors.forename: Emel
authors.initials: E
authors.lastname: Bulbul Baskan
authors.forename: Nihan
authors.initials: N
authors.lastname: Alkis
authors.forename: Mustafa
authors.initials: M
authors.lastname: Gullulu
authors.forename: Mahmut
authors.initials: M
authors.lastname: Yavuz
authors.forename: Kamil
authors.initials: K
authors.lastname: Dilek
authors.forename: Alpaslan
authors.initials: A
authors.lastname: Ersoy
authors.forename: Mustafa
authors.initials: M
authors.lastname: Yurtkuran
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D057915:Drug Substitution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D012867:Skin / Q000187:drug effects / Q000473:pathology; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha