Psoriasis Induced by Anti-TNF Therapy

Title: Psoriasis induced by anti-tumor necrosis factor therapy: a paradoxical adverse reaction
: Sfikakis PP
Publication: Arthritis Rheum. 2005 Aug;52(8):2513-8.

Administration of anti-tumor necrosis factor (anti-TNF) agents is beneficial for various chronic inflammatory conditions, including psoriasis.

The authors described 5 patients who developed psoriasis 6 to 9 months after the initiation of anti-TNF therapy for chronic rheumatoid arthritis (using etanercept or adalimumab drugs), ankylosing spondylitis (infliximab), and Adamantiades-Behcet’s disease (infliximab).

In all these 5 patients, the anti-TNF therapy worked well against those diseases. However, 4 patients developed pustules or lesions in the palms and/or soles of their feet, along with plaque-like psoriasis at other skin sites. Another patient developed thick erythematous scaly plaques at the scalp.

Three patients’ nails developed onycholysis or separation of the nails from its nail bed, yellow discoloration, and keratosis (excessive growth of horny tissues) below the nail.

Skin biopsies were consistent with psoriasis, however, none of the patients had a family history of this condition. In all patients, the skin lesions went away either with topical treatment or after discontinuation of the anti-TNF therapy.

The authors noted anti-TNF therapy may trigger psoriasis by altering the body’s immune system by inhibiting TNF activity in certain individuals.

Editor’s Note:
  • TNF is a cytokine (a type of protein involved in the immune reaction) that is released by white blood cells. It inhibits abnormal cell growth, but can cause inflammation.
  • Ankylosing spondylitis is a form of arthritis that affects the spine.
  • Adamantiades-Behcet’s disease or Behcet’s syndrome is a rare inflammatory disorder that is characterized by skin ulcers or lesions in the mouth, genitals, and around the eyes. The exact cause of this disease is not known.
  • Erythematous refers erythema or redness of the skin caused by dilation of the blood vessels, and is often a sign of inflammation or infection.

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