title: The association of psoriasiform rash with anti-tumor necrosis factor (anti-TNF) therapy in inflammatory bowel disease: a single academic center case series.
abstract: OBJECTIVE
  Anti-tumor necrosis factors (anti-TNF) including infliximab, adalimumab and certolizumab pegol are used to treat Crohn's disease (CD) and ulcerative colitis (UC). Paradoxically, while also indicated for the treatment of psoriasis, anti-TNF therapy has been associated with development of psoriasiform lesions in IBD patients and can compel discontinuation of therapy. We aim to investigate IBD patient, clinical characteristics, and frequency for the development of and outcomes associated with anti-TNF induced psoriasiform rash.
  
  
  METHODS
  We identify IBD patients on anti-TNFs with an onset of a psoriasiform rash. Patient characteristics, duration of anti-TNF, concomitant immunosuppressants, lesion distribution, and outcomes of rash are described.
  
  
  RESULTS
  Of 1004 IBD patients with exposure to anti-TNF therapy, 27 patients (2.7%) developed psoriasiform lesions. Psoriasiform rash cases stratified by biologic use were 1.3% for infliximab, 4.1% for adalimumab, and 6.4% for certolizumab. Average time on treatment (206.3weeks) and time on treatment until onset of psoriasiform lesions (126.9weeks) was significantly higher in the infliximab group. The adalimumab group had the highest need for treatment discontinuation (60%). The majority (59.3%) of patients were able to maintain on anti-TNFs despite rash onset. Among patients that required discontinuation (40.7%), the majority experienced improvement with a subsequent anti-TNF (66.7%).
  
  
  CONCLUSIONS
  27 cases of anti-TNF associated psoriasiform lesions are reported. Discontinuation of anti-TNF treatment is unnecessary in the majority. Dermatologic improvement was achieved in the majority with a subsequent anti-TNF, suggesting anti-TNF induced psoriasiform rash is not necessarily a class effect.
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, United States; Inflammatory Bowel Disease Program, University of Washington Medical Center, Seattle, WA, United States. Electronic address: anitaa@medicine.washington.edu.
authors.forename: Anita
authors.initials: A
authors.lastname: Afzali
authors.affiliation: Inflammatory Bowel Disease Program, University of Washington Medical Center, Seattle, WA, United States.
authors.forename: Chelle L
authors.initials: CL
authors.lastname: Wheat
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA, United States.
authors.forename: Jie Kate
authors.initials: JK
authors.lastname: Hu
authors.affiliation: Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA, United States.
authors.forename: John E
authors.initials: JE
authors.lastname: Olerud
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, United States; Inflammatory Bowel Disease Program, University of Washington Medical Center, Seattle, WA, United States.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Lee
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use; D000068582:Certolizumab Pegol; D003093:Colitis, Ulcerative / Q000188:drug therapy; D003424:Crohn Disease / Q000188:drug therapy; D005076:Exanthema / Q000139:chemically induced*; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D000069285:Infliximab; D008297:Male; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000627:therapeutic use; D011565:Psoriasis / Q000139:chemically induced*; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007140:Immunoglobulin Fab Fragments; D014409:Tumor Necrosis Factor-alpha; D011092:Polyethylene Glycols; D000069285:Infliximab; D000068879:Adalimumab; D000068582:Certolizumab Pegol
keywords: Biologic therapy; Crohn's enterocolitis; Cutaneous manifestations; Dermatologic reactions; Psoriasiform rash; Ulcerative colitis