Injection Site Reactions to Biologic Agents Used in Psoriasis and Psoriatic Arthritis

Psoriasis is a chronic inflammatory cutaneous disease that affects 2-3% of the general population. Up to 30% of patients with psoriasis also develop psoriatic arthritis, a chronic inflammatory and progressive arthritis. Although their precise pathogeneses remain unclear, psoriasis and psoriatic arthritis involve altered expression of proinflammatory cytokines, including tumor necrosis factor-alpha, interleukin (IL)-12, IL-17, IL-22, and IL-23. The development of biologic agents that target these cytokines has greatly improved the treatment of psoriatic disease. Injection site reactions have been reported with many of these therapies. In this paper, we will present cases and review the literature on injection site reactions with the major biologic agents administered subcutaneously for the treatment of psoriasis and psoriatic arthritis.