title: Induction or exacerbation of psoriatic lesions during anti-TNF-α therapy for inflammatory bowel disease: a systematic literature review based on 222 cases.
abstract: BACKGROUND
  Paradoxical cases of psoriatic lesions induced or exacerbated by anti-tumor necrosis factor (TNF)-α therapy have been reported more frequently in recent years, but data related to inflammatory bowel disease (IBD) are rare. A systematic literature review was performed to provide information about this adverse effect in patients with IBD who receive anti-TNF therapy.
  
  
  METHODS
  Published studies were identified by a search of Medline, Embase, Cochrane, SciELO, and LILACS databases.
  
  
  RESULTS
  A total of 47 studies (222 patients) fulfilled the inclusion criteria and were selected for analysis. Clinical and therapeutic aspects varied considerably among these reports. Of the 222 patients, 78.38% were diagnosed with Crohn's disease, and 48.20% were female. The mean patient age was 26.50 years, and 70.72% of patients had no history of psoriasis. Patients developed psoriasiform lesions (55.86%) more often than other types of psoriatic lesions, and infliximab was the anti-TNF-α therapy that caused the cutaneous reaction in most patients (69.37%). Complete remission of cutaneous lesions was observed in 63.96% of the cases.
  
  
  CONCLUSIONS
  We found that psoriatic lesions occurred predominantly in adult patients with Crohn's disease who received infliximab and had no previous history of psoriasis. Most patients can be managed conservatively without discontinuing anti-TNF-α therapy.
authors.affiliation: Division of Coloproctology, Department of Surgery, School of Medical Sciences, University of the State of São Paulo, Botucatu, SP, Brazil. denadai.rafael@hotmail.com
authors.forename: Rafael
authors.initials: R
authors.lastname: Denadai
authors.forename: Fábio Vieira
authors.initials: FV
authors.lastname: Teixeira
authors.forename: Flavio
authors.initials: F
authors.lastname: Steinwurz
authors.forename: Ricardo
authors.initials: R
authors.lastname: Romiti
authors.forename: Rogério
authors.initials: R
authors.lastname: Saad-Hossne
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D005765:Gastrointestinal Agents / Q000009:adverse effects*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D000069285:Infliximab; D011565:Psoriasis / Q000139:chemically induced*
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab