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Psoriasiform Skin Lesions Are Caused by Anti-TNF Agents Used for the Treatment of Inflammatory Bowel Disease

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Abstract

Background

Tumor necrosis factor (TNF) antagonists used for the treatment of inflammatory bowel disease (IBD) have been associated with the development of psoriasiform skin lesions. We assessed the demographic and clinical characteristics associated with and outcomes of patients with anti-TNF-induced psoriasiform lesions.

Methods

Patients with Crohn’s disease (CD) and ulcerative colitis (UC) receiving treatment with anti-TNF therapy (infliximab, adalimumab, or certolizumab pegol) at a tertiary referral center were identified using an IRB-approved clinical data repository. Patients that developed psoriasiform skin lesions after initiation of anti-TNF therapy were included as cases. A group of anti-TNF-treated patients without drug-related psoriasiform lesions were identified as controls. The association between demographic and clinical variables and psoriasiform lesions was assessed using Chi-square analyses and multivariable logistic regression.

Results

Five hundred twenty-one patients with IBD undergoing treatment with anti-TNF therapy were identified; of these, 18 (3.5 %) had psoriasiform lesions (16 CD and 2 UC). Seventy-two patients were identified as controls. Lesions developed a mean of 58 weeks (range 4–240 weeks) after starting anti-TNF therapy. The majority of patients were female and Caucasian (63 and 78 %, respectively). Thirty-nine percent of patients had upper tract disease location. Forty-five patients (50 %) were current or former smokers. Location of psoriasiform lesions included palmo-plantar (53 %), trunk (47 %), and scalp (53 %), with 88 % reporting involvement of ≥2 locations. Treatment of psoriasiform lesions was instituted with topical therapy in eight patients and systemic therapy (± phototherapy) in five patients. Discontinuation of anti-TNF therapy was recommended in nine patients (50 %); of those, three were retreated with a second anti-TNF agent and all had recurrence of psoriasiform lesions. When adjusted for multiple variables, upper GI tract disease was significantly associated with psoriasiform lesions.

Conclusions

Anti-TNF-induced psoriasiform lesions developed in 3.5 % of patients with IBD at a tertiary referral center. Similar to prior published studies, most patients were female, had involvement of the palmo-plantar and scalp regions, and did not have severe IBD activity. The presence of upper tract disease was associated with the development of psoriasiform lesions. Skin lesions led to discontinuation of anti-TNF therapy in 50 % of patients. Based upon these results, IBD providers should educate patients about this adverse effect, refer to dermatology for treatment, and discuss alternative IBD therapeutic options early if a severe psoriasiform rash develops.

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Conflict of interest

Raymond K. Cross, MD, MS, has a research grant from Abbvie, Inc. He has received income from consulting and participated in advisory boards with Abbvie Inc., Janssen, and Takeda Pharmaceuticals International, Inc. Leyla J. Ghazi, MD, has participated in advisory boards for Abbvie, Inc.

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Authors and Affiliations

  1. Department of Medicine, University of Maryland School of Medicine, 100 North Greene Street, Lower Level, Baltimore, MD, 21201, USA

    Lauren A. George, Akash Gadani, Raymond K. Cross & Leyla J. Ghazi

  2. Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, MD, USA

    Raymond K. Cross, Guruprasad Jambaulikar & Leyla J. Ghazi

  3. Veterans Affairs, Maryland Health Care System, Baltimore, MD, USA

    Leyla J. Ghazi

Authors
  1. Lauren A. George
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  2. Akash Gadani
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Correspondence to Leyla J. Ghazi.

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George, L.A., Gadani, A., Cross, R.K. et al. Psoriasiform Skin Lesions Are Caused by Anti-TNF Agents Used for the Treatment of Inflammatory Bowel Disease. Dig Dis Sci 60, 3424–3430 (2015). https://doi.org/10.1007/s10620-015-3763-0

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  • DOI: https://doi.org/10.1007/s10620-015-3763-0

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