title: Proactive infectious disease approach to dermatologic patients who are taking tumor necrosis factor-alfa antagonists: Part I. Risks associated with tumor necrosis factor-alfa antagonists.
abstract: Tumor necrosis factor-alfa levels are linked to disease severity in patients with inflammatory conditions, such as psoriasis. Inhibitors of this cytokine are commonly used with significant success in the treatment of such inflammatory disorders. Their use, however, can be plagued by infectious complications. An awareness of potential infections associated with these therapies is critical in order to maximize preventive efforts both before and during therapy. This review provides a guide for dermatologists caring for patients in need of this type of biologic therapy to preemptively address the infectious risks. Part I of this continuing medical education article reviews background information on the various infectious risks associated with tumor necrosis factor inhibitor therapy and appropriate historical data to obtain in the context of pretherapy evaluations.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Connecticut Health Center, Farmington, Connecticut.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Chirch
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Connecticut Health Center, Farmington, Connecticut.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Cataline
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Connecticut Health Center, Farmington, Connecticut.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Dieckhaus
authors.affiliation: Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut. Electronic address: grant@uchc.edu.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Grant-Kels
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects; D001691:Biological Therapy / Q000009:adverse effects*; D001759:Blastomycosis / Q000139:chemically induced / Q000150:complications; D003047:Coccidioidomycosis / Q000139:chemically induced / Q000150:complications; D003141:Communicable Diseases / Q000139:chemically induced / Q000150:complications* / Q000276:immunology; D018450:Disease Progression; D019353:Endemic Diseases; D006660:Histoplasmosis / Q000139:chemically induced / Q000150:complications; D006801:Humans; D008487:Medical History Taking; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy; D018570:Risk Assessment; D012871:Skin Diseases / Q000150:complications* / Q000188:drug therapy*; D014376:Tuberculosis / Q000139:chemically induced / Q000150:complications; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology; D000069549:Ustekinumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D000069549:Ustekinumab
keywords: biologic therapy; endemic mycoses; opportunistic infection; psoriasis; tuberculosis; tumor necrosis factor