title: Psoriasiform reactions to anti-tumor necrosis factor α therapy.
abstract: OBJECTIVE
  Given increasing concern about the adverse effects of anti-tumor necrosis factor α (anti-TNF-α) medications, we sought to characterize psoriasiform eruptions in patients on these medications.
  
  
  METHODS
  In a retrospective review of patients at the Brigham and Women's Hospital combined dermatology-rheumatology clinic, we identified 13 patients (1 male and 12 female patients) who developed psoriasiform eruptions while on anti-TNF-α medications.
  
  
  RESULTS
  Inciting medications were adalimumab, etanercept, and infliximab. Patients were on their inciting medication for a median time of 24 months and a mean time of 31.3 months before developing eruptions. Five of 7 patients experienced complete resolution of lesions with topical corticosteroids and discontinuation of anti-TNF-α medications with the remaining 2 patients having partial improvement. One of the other 6 patients experienced complete resolution with topical corticosteroid treatment only, with the remaining 5 patients experiencing partial improvement. After changing anti-TNF-α agents, 1 patient had partial improvement of psoriasiform lesions, and 7 patients had no improvement.
  
  
  CONCLUSIONS
  All of the main anti-TNF-α medications currently used are capable of causing psoriasiform eruptions. Poor responders to topical agents, such as corticosteroids, may benefit from supplemental therapy aimed at the psoriasiform eruption or changing to a different class of immunomodulatory agents. Switching anti-TNF-α medications had a low likelihood of improving psoriasiform skin reactions, further suggesting that these eruptions are a drug class effect.
authors.affiliation: From the *Department of Dermatology, †Division of Rheumatology, Allergy and Immunology, Department of Medicine, Channing Laboratory, and ‡Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Khang
authors.initials: K
authors.lastname: Nguyen
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Vleugels
authors.forename: Nicole F
authors.initials: NF
authors.lastname: Velez
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Merola
authors.forename: Abrar A
authors.initials: AA
authors.lastname: Qureshi
mesh_terms: D000068879:Adalimumab; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D000068800:Etanercept; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011565:Psoriasis / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D028761:Withholding Treatment
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept