title: Induction of psoriasis with anti-TNF agents in patients with inflammatory bowel disease: a report of 21 cases.
abstract: OBJECTIVE
  Anti-tumor necrosis factor (TNF)-alpha agents are widely used for the treatment of both inflammatory bowel disease (IBD) and psoriasis. Psoriatic skin lesions induced by anti-TNF have been described in patients with IBD. We report a case series of psoriasis induced by anti-TNF agents in IBD patients.
  
  
  METHODS
  Systematic analysis of cases of psoriasis induced by anti-TNF in an IBD patient cohort in tertiary hospitals of Madrid.
  
  
  RESULTS
  A total of 21 of 1294 patients with IBD treated with anti-TNF-alpha agents developed drug-induced psoriasis (cumulative incidence 1.62%; 95% CI 1.06%-2.47%): 14 patients with infliximab and 7 with adalimumab; seventeen with Crohn's disease, 4 with ulcerative colitis. The onset of skin lesions varied in a wide range of time (after a mean 13±8 doses). The most frequent site of skin lesions was the limbs (62%) followed by the trunk (48%) and the scalp (43%). The psoriasis phenotypes were plaque psoriasis (57%), scalp (14%), palmoplantar pustulosis (14%), pustular generalized psoriasis (5%), guttate (5%) and inverse (5%). Four patients interrupted the anti-TNF treatment, and that led to the complete regression of lesions in 1 of them. The other 17 patients were maintained on anti-TNF therapy and managed with topical steroids.
  
  
  CONCLUSIONS
  Psoriatic lesions can be induced by anti-TNF drugs. Plaque psoriasis on the extremities and trunk were the most frequent presentations in our series. Topical steroid treatment is effective in most patients. Anti-TNF discontinuance may be reserved for patients with severe psoriasis or patients without response to topical therapy.
authors.affiliation: Digestive Diseases Department, Hospital de Fuenlabrada, Spain. ivan.guerra@salud.madrid.org
authors.forename: Iván
authors.initials: I
authors.lastname: Guerra
authors.forename: Alicia
authors.initials: A
authors.lastname: Algaba
authors.forename: José Lázaro
authors.initials: JL
authors.lastname: Pérez-Calle
authors.forename: María
authors.initials: M
authors.lastname: Chaparro
authors.forename: Ignacio
authors.initials: I
authors.lastname: Marín-Jiménez
authors.forename: Raquel
authors.initials: R
authors.lastname: García-Castellanos
authors.forename: Yago
authors.initials: Y
authors.lastname: González-Lama
authors.forename: Antonio
authors.initials: A
authors.lastname: López-Sanromán
authors.forename: Noemí
authors.initials: N
authors.lastname: Manceñido
authors.forename: Pilar
authors.initials: P
authors.lastname: Martínez-Montiel
authors.forename: Elvira
authors.initials: E
authors.lastname: Quintanilla
authors.forename: Carlos
authors.initials: C
authors.lastname: Taxonera
authors.forename: Mónica
authors.initials: M
authors.lastname: Villafruela
authors.forename: Alberto
authors.initials: A
authors.lastname: Romero-Maté
authors.forename: Pilar
authors.initials: P
authors.lastname: López-Serrano
authors.forename: Javier P
authors.initials: JP
authors.lastname: Gisbert
authors.forename: Fernando
authors.initials: F
authors.lastname: Bermejo
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D000069285:Infliximab; D008297:Male; D011565:Psoriasis / Q000139:chemically induced* / Q000150:complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab