Repeated Paradoxical Aggravation of Preexisting Psoriasis during Infliximab Treatment for Crohn's Disease

Abstract

As more rheumatologists and dermatologists have begun to use biological agents such as TNF-alpha blocker, they have confronted an unexpected complication: psoriasis was paradoxically aggravated or induced by the TNF-alpha blocker. Although it is not a common complication of TNF-alpha blocker, this aggravation may be more common than previously thought. To our knowledge, most reports about TNF-alpha blocker-induced psoriasis have been limited to western countries while only a few cases have been reported in Korea and Japan. In addition, new onset of pustular psoriasis by TNF-alpha blocker has been reported more commonly than worsening of preexisting psoriasis. Now we report a patient whose preexisting psoriasis vulgaris was aggravated repeatedly after using the TNF-alpha blocker, infliximab, to control Crohn's disease, which is a rare rheumatologic disease in Korea.

Keywords: Aggravation; Crohn's disease; Psoriasis; TNF-α blocker.

Fig. 1

The patient had almost recovered from her aggravated psoriasis with UVB phototherapy and topical steroid before the sixth infliximab treatment.

Fig. 2

Multiple pruritic erythematous papules and scales developed again and aggravated on her face and extremities after 5 days of the sixth infusion of infliximab.