Psoriasis induced by anti-tumor necrosis factor therapy - A paradoxical adverse reaction

被引:235
作者
Sfikakis, PP
Iliopoulos, A
Elezoglou, A
Kittas, C
Stratigos, A
机构
[1] Univ Athens, Sch Med, Athens, Greece
[2] Gen Mil Hosp Athens, Athens, Greece
来源
ARTHRITIS AND RHEUMATISM | 2005年 / 52卷 / 08期
关键词
D O I
10.1002/art.21233
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Administration of anti-tumor necrosis factor (anti-TNF) agents is beneficial in a variety of chronic inflammatory conditions, including psoriasis. We describe 5 patients in whom psoriasiform skin lesions developed 6-9 months after the initiation of anti-TNF therapy for longstanding, seropositive rheumatoid arthritis (etanercept or adalimumab), typical ankylosing spondylitis (infliximab), and Adamantiades-Behcet's disease (infliximab). In all 5 patients, the underlying disease had responded well to anti-TNF therapy. Four patients developed a striking pustular eruption on the palms and/or soles accompanied by plaque-type psoriasis at other skin sites, while 1 patient developed thick erythematous scaly plaques localized to the scalp. In 3 patients there was nail involvement with onycholysis, yellow discoloration, and subungual keratosis. Histologic findings from skin biopsies were consistent with psoriasis. None of these patients had a personal or family history of psoriasis. In all patients, skin lesions subsided either with topical treatment alone, or after discontinuation of the responsible anti-TNF agent. The interpretation of this paradoxical side effect of anti-TNF therapy remains unclear but may relate to altered immunity induced by the inhibition of TNF activity in predisposed individuals.
引用
收藏
页码:2513 / 2518
页数:6
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