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. 2017 Feb;76(2):334-341.
doi: 10.1016/j.jaad.2016.08.012. Epub 2016 Oct 5.

Tumor necrosis factor-α inhibitor-induced psoriasis: Systematic review of clinical features, histopathological findings, and management experience

Gabrielle Brown  1 , Eva Wang  1 , Argentina Leon  1 , Monica Huynh  1 , Mackenzie Wehner  1 , Rebecca Matro  2 , Eleni Linos  1 , Wilson Liao  1 , Anna Haemel  3
Affiliations

Tumor necrosis factor-α inhibitor-induced psoriasis: Systematic review of clinical features, histopathological findings, and management experience

Gabrielle Brown et al. J Am Acad Dermatol. 2017 Feb.

Abstract

Background: Tumor necrosis factor-α (TNF-α) inhibitors have been reported to induce new-onset psoriasis.

Objective: To better define the demographic, clinical features, and treatment approach of TNF-α inhibitor-induced psoriasis.

Methods: Systematic review of published cases of TNF-α inhibitor-induced psoriasis.

Results: We identified 88 articles with 216 cases of new-onset TNF-α inhibitor-induced psoriasis. The mean age at psoriasis onset was 38.5 years. The most common underlying diseases were Crohn disease (40.7%) and rheumatoid arthritis (37.0%). Patients underwent TNF-α therapy for an average of 14.0 months before psoriasis onset with 69.9% of patients experiencing onset within the first year. The majority of patients received skin-directed therapy, though patients who discontinued TNF therapy had the greatest resolution of symptoms (47.7%) compared with those who switched to a different TNF agent (36.7%) or continued therapy (32.9%).

Limitations: Retrospective review that relies on case reports and series.

Conclusion: While TNF-α inhibitor cessation may result in resolution of induced psoriasis, lesions may persist. Decisions regarding treatment should be weighed against the treatability of TNF-α inhibitor-induced psoriasis, the severity of the background rheumatologic or gastrointestinal disease, and possible loss of efficacy with cessation followed by retreatment. Skin-directed therapy is a reasonable initial strategy except in severe cases.

Keywords: adalimumab; adverse event; certolizumab; etanercept; golimumab; infliximab; medication side effect; psoriasis; tumor necrosis factor-α inhibitor; tumor necrosis factor-α-induced psoriasis.

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Conflict of interest statement

Conflict of Interest Disclosure:

The authors do not report any conflicts of interest.

Figures

Figure 1:
Figure 1:
The electronic search, selection and exclusion of studies in the systematic review.
See this image and copyright information in PMC

References

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