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Psoriasis Induced by Tumor Necrosis Factor-a Antagonist Therapy: A Case Series
JEAN DAVID COHEN, IRINA BOURNERIAS, VALÉRIE BUFFARD, AGNÈS PAUFLER, XAVIER CHEVALIER, MARTINE BAGOT, and PASCAL CLAUDEPIERRE ABSTRACT. Objective. Although tumor necrosis factor-a (TNF-a) antagonists are effective in the treatment of refractory psoriasis, some cases have suggested that psoriasis might be induced as a result of treatment prescribed mainly for rheumatoid arthritis, ankylosing spondylitis, and Crohn's disease. To investigate anti-TNF-a induced psoriasis, we conducted a systematic analysis of the 6 cases we observed among our inflammatory patient cohort treated with anti-TNF-a (infliximab or etanercept). Methods. We report 6 cases of psoriasis with onset during TNF-a antagonist therapy (infliximab and etanercept); characteristics and skin lesions are described. Results. No patient had a personal or family history of psoriasis. The development of psoriasis was seen in all the types of inflammatory diseases we treated with TNF-a antagonists. There was great variation in the age of affected patients and in the onset of psoriasis after initiation of TNF-a antagonists. Both TNF-a antagonists studied were associated with development of psoriasis. In 2 cases psoriasis was associated with 2 different TNF-a antagonists in the same patient. In half our patients, skin lesions started in the inguinal and pubic regions, but palmoplantar pustulosis was also common. In half the cases, skin lesions responded favorably with topical agents despite continuation of TNF-a antagonist therapy. Conclusion. In light of previously published cases describing psoriasis or psoriasiform lesions after TNF-a antagonist therapy, our series strongly confirms that TNF-a antagonists may induce psoriasis in some patients. Further studies are needed to identify risk factors for TNF-a antagonist induced psoriasis. (First Release Oct 1 2006; J Rheumatol 2007;34:380–5) Key Indexing Terms:
PSORIASIS From the Departments of Rheumatology and Dermatology, Henri Mondor Teaching Hospital, APHP, Créteil; and Department of Internal Medicine, General Hospital of Villeneuve, Saint-Georges, France. J.D. Cohen, MD; X. Chevalier, MD, PhD; P. Claudepierre, MD, Department of Rheumatology; I. Bournerias, MD; V. Buffard, MD; M. Bagot, MD, PhD, Department of Dermatology; A. Paufler, MD, Department of Internal Medicine, General Hospital of Villeneuve. Address reprints requests to Prof. P. Claudepierre, Service de Rhumatologie, Hôpital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil CEDEX, France. E-mail: pascal.claudepierre@hmn.ap-hop-paris.fr Accepted for publication June 21, 2006.
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