title: Psoriasis and Psoriasiform Eruptions in Pediatric Patients with Inflammatory Bowel Disease Treated with Anti-Tumor Necrosis Factor Alpha Agents.
abstract: BACKGROUND
  Anti-tumor necrosis factor alpha (TNF-α) agents are used to treat a variety of autoimmune and inflammatory conditions, including psoriasis. Paradoxically, numerous reports have documented new-onset or exacerbation of psoriasis or psoriasiform skin lesions (PSO) in patients treated with these agents for conditions other than PSO-particularly in adults with inflammatory bowel disease (IBD). Not much is known regarding similar cases in children.
  
  
  METHODS
  A retrospective chart review was performed on children younger than 19 years of age with IBD seen at the Mayo Clinic between 2003 and 2015 who developed new-onset or recurrent PSO while undergoing anti-TNF-α therapy.
  
  
  RESULTS
  Fourteen children developed PSO while undergoing anti-TNF-α therapy for IBD. All three anti-TNF-α agents (infliximab, adalimumab, certolizumab) used to treat IBD in this series led to induction or recurrence of PSO lesions. The median time to development of PSO was 11 months (range 0-48 mos), the median age was 15 years (range 12.5-17.5 yrs), and 57% of patients were male. IBD activity was quiescent in 93% of cases at PSO onset. Seven patients (50%) discontinued their initial anti-TNF-α therapy because of their skin disease. Ultimately, four patients (29%) had to discontinue all anti-TNF-α therapy to induce PSO resolution.
  
  
  CONCLUSIONS
  TNF-α antagonist-induced PSO in children with IBD is a rarely reported adverse reaction. PSO onset has a variable latency, but usually occurs during IBD remission, with a slight male bias. Nearly half of patients required a change in their initial anti-TNF-α agent despite conventional skin-directed therapies, and one-third of patients discontinued all anti-TNF-α therapy because of PSO.
authors.affiliation: Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Eickstaedt
authors.affiliation: LewisGale Hospital Montgomery, Blacksburg, Virginia.
authors.forename: Luke
authors.initials: L
authors.lastname: Killpack
authors.affiliation: Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Tung
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Dawn
authors.initials: D
authors.lastname: Davis
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.|Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota.|Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Hand
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Megha M
authors.initials: MM
authors.lastname: Tollefson
mesh_terms: D000046:Academic Medical Centers; D000068879:Adalimumab / Q000009:adverse effects / Q000627:therapeutic use; D000293:Adolescent; D017677:Age Distribution; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000188:drug therapy*; D000069285:Infliximab / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D015995:Prevalence; D011565:Psoriasis / Q000139:chemically induced* / Q000453:epidemiology* / Q000473:pathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014481:United States; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab