Paradoxical Plaque Psoriasis on Infliximab in a Patient with Behçet's Disease

Abstract

TNF inhibitors are used in a number of diseases, including Behçet's disease and particularly its ophthalmological manifestations in cases of resistance or progression under conventional systemic treatments, notably corticosteroids. These TNF inhibitors are not without side effects, some of which are paradoxical in that they manifest themselves in diseases classically treated by these agents, such as psoriasis. Our case report is about a 25-year-old Behçet patient who received infliximab for corticoresistant uveitis. His uveitis has subsided but he developed a diffuse psoriasiform eruption 21 months after its introduction. Infliximab was discontinued and the patient was treated with emollients, dermocorticoids and phototherapy with a favorable outcome. Paradoxical psoriasis occurs from a few days to several years after the introduction of TNF inhibitors, it may resemble psoriasis vulgaris or differ from it in terms of flexural fold involvement, more frequent pustular involvement of the palms and soles, and scalp involvement complicated by severe non-scarring alopecia. The histology of paradoxical psoriasis typically combines psoriatic, eczematiform and lichenoid patterns. When paradoxical psoriasis is moderate or severe, and the underlying pathology is controlled, we can treat the psoriatic flare and switch to another TNF inhibitor, something the Internal Medicine Department has not been very receptive to.