Cutaneous adverse effects of tumor necrosis factor alpha antagonists
| Examples | Cutaneous side effects | Management strategies |
|---|---|---|
| Adalimumab Certolizumab Etanercept Golimumab Infliximab | Infusion reactions and injection site reactions | Preinfusion treatment with oral antihistamines, acetaminophen, and intravenous steroids |
| Cutaneous infections (bacterial, viral) | Frequent skin examinations, low threshold to perform cultures and initiate bacterial or fungal-targeted topical or oral therapy Consider varicella zoster vaccination before starting therapy | |
| Psoriasis | Topical therapy, methotrexate, cyclosporine, phototherapy | |
| Eczematous dermatitis | Gentle skin care, liberal emollients, topical steroids | |
| Lichenoid reactions | Discontinuation or reduction of therapy dose, topical steroids | |
| Cutaneous leukocytoclastic vasculitis | Discontinuation of therapy, initiation of systemic prednisone, switch to other immunosuppressive medication | |
| Nonmelanoma and melanoma skin cancer | Routine skin cancer surveillance, broad-spectrum sunscreen, sun avoidance, skin self-examination |