title: Tumor necrosis factor-α inhibitor-induced psoriasis: Systematic review of clinical features, histopathological findings, and management experience.
abstract: BACKGROUND
  Tumor necrosis factor-α (TNF-α) inhibitors have been reported to induce new-onset psoriasis.
  
  
  OBJECTIVE
  To better define the demographic, clinical features, and treatment approach of TNF-α inhibitor-induced psoriasis.
  
  
  METHODS
  Systematic review of published cases of TNF-α inhibitor-induced psoriasis.
  
  
  RESULTS
  We identified 88 articles with 216 cases of new-onset TNF-α inhibitor-induced psoriasis. The mean age at psoriasis onset was 38.5 years. The most common underlying diseases were Crohn disease (40.7%) and rheumatoid arthritis (37.0%). Patients underwent TNF-α therapy for an average of 14.0 months before psoriasis onset with 69.9% of patients experiencing onset within the first year. The majority of patients received skin-directed therapy, though patients who discontinued TNF therapy had the greatest resolution of symptoms (47.7%) compared with those who switched to a different TNF agent (36.7%) or continued therapy (32.9%).
  
  
  CONCLUSIONS
  Retrospective review that relies on case reports and series.
  
  
  CONCLUSIONS
  While TNF-α inhibitor cessation may result in resolution of induced psoriasis, lesions may persist. Decisions regarding treatment should be weighed against the treatability of TNF-α inhibitor-induced psoriasis, the severity of the background rheumatologic or gastrointestinal disease, and possible loss of efficacy with cessation followed by retreatment. Skin-directed therapy is a reasonable initial strategy except in severe cases.
authors.affiliation: Department of Dermatology, University of California, San Francisco, California.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Brown
authors.affiliation: Department of Dermatology, University of California, San Francisco, California.
authors.forename: Eva
authors.initials: E
authors.lastname: Wang
authors.affiliation: Department of Dermatology, University of California, San Francisco, California.
authors.forename: Argentina
authors.initials: A
authors.lastname: Leon
authors.affiliation: Department of Dermatology, University of California, San Francisco, California.
authors.forename: Monica
authors.initials: M
authors.lastname: Huynh
authors.affiliation: Department of Dermatology, University of California, San Francisco, California.
authors.forename: Mackenzie
authors.initials: M
authors.lastname: Wehner
authors.affiliation: Department of Gastroenterology, University of California, San Francisco, California.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Matro
authors.affiliation: Department of Dermatology, University of California, San Francisco, California.
authors.forename: Eleni
authors.initials: E
authors.lastname: Linos
authors.affiliation: Department of Dermatology, University of California, San Francisco, California.
authors.forename: Wilson
authors.initials: W
authors.lastname: Liao
authors.affiliation: Department of Dermatology, University of California, San Francisco, California. Electronic address: Anna.Haemel@ucsf.edu.
authors.forename: Anna
authors.initials: A
authors.lastname: Haemel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003875:Drug Eruptions / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D014409:Tumor Necrosis Factor-alpha
keywords: adalimumab; adverse event; certolizumab; etanercept; golimumab; infliximab; medication side effect; psoriasis; tumor necrosis factor-α inhibitor; tumor necrosis factor-α-induced psoriasis