Perioperative management of tumor necrosis factor-alpha blocker-treated psoriatic patients: Case reports and review.
Regarding appropriate timings of discontinuation and resumption of biologics for psoriasis patients before and after elective surgeries, an international consensus has yet to be reached. The Japanese Dermatological Association of Guideline and Safety Manual for the use of Biologic Agents in Psoriasis 2013 states that infliximab (IFX) and adalimumab (ADA) should be withheld at least 4 and 2 weeks, respectively, before surgery and can be restarted as neither postoperative infection nor delayed wound healing is recognized. We experienced three generalized pustular psoriasis (GPP) patients and one plaque-type psoriasis patient undergoing surgeries during tumor necrosis factor (TNF)-α blocker therapy. Three GPP cases experienced uneventful post-surgical course. One psoriasis vulgaris patient on IFX had a wound healing delay with deterioration of psoriatic plaques which was restored by restarting IFX. The timing of suspension and resumption of TNF-α blockers in all cases were determined following the Japanese guideline.
Department of Dermatology, Tokyo Medical University, Tokyo, Japan.
Hiroshi
H
Kawakami
Department of Dermatology, Tokyo Medical University, Tokyo, Japan.
Yuka
Y
Matsumoto
Department of Dermatology, Tokyo Medical University, Tokyo, Japan.
Namiko
N
Abe
Department of Orthopedics, Tokyo Medical University, Tokyo, Japan.
Youich
Y
Katori
Department of Gastroenterological Surgery, Tokyo Medical University, Tokyo, Japan.
Kousuke
K
Takahashi
Department of Dermatology, Tokyo Medical University, Tokyo, Japan.
Ryoji
R
Tsuboi
Department of Dermatology, Tokyo Medical University, Tokyo, Japan.
Yukari
Y
Okubo
D000068879:Adalimumab / Q000008:administration & dosage; D000328:Adult; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D017410:Practice Guidelines as Topic; D011565:Psoriasis / Q000601:surgery* / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab
adalimumab; biologics; elective surgery; infliximab; methotrexate; tumor necrosis factor-alpha blockers