Abstract
A 46-year-old, caucasian woman suffering from Crohn’s disease and a 35-year-old woman suffering from ankylosing spondylitis were treated with the TNFα blocker infliximab and developed psoriasiform skin lesions. The pathophysiology of this paradoxical clinical response as a newly recognized adverse effect of TNFα antagonists is unknown. According to the literature, this type of newly triggered psoriasis may occur any time after initiation of TNFα antagonist therapy and responds to classic antipsoriatic treatment. The phenomenon warrants attention, especially when considering anti-TNFα treatment in various skin diseases besides psoriasis.
Highlights
Tumor necrosis factor α (TNFα) inhibitors, such as the monoclonal antibodies infliximab, adalimumab and the receptor antagonist etanercept, are used successfully for the therapy of several autoimmune disorders as well as diseases associated with a Th1 profile [secretion of interleukin-1, TNFα and interferon-γ]
Clinical efficacy of anti-TNF treatment has been established in rheumatoid arthritis, Crohn’s Disease [1], ankylosing spondylitis [2] and in psoriasis [3]
We report two cases of newly triggered psoriasiform skin lesions in patients who had been treated with infliximab for Crohn’s disease and ankylosing spondylitis
Summary
Tumor necrosis factor α (TNFα) inhibitors, such as the monoclonal antibodies infliximab, adalimumab and the receptor antagonist etanercept, are used successfully for the therapy of several autoimmune disorders as well as diseases associated with a Th1 profile [secretion of interleukin-1, TNFα and interferon-γ]. Clinical efficacy of anti-TNF treatment has been established in rheumatoid arthritis, Crohn’s Disease [1], ankylosing spondylitis [2] and in psoriasis [3]. Infliximab is a monoclonal human-mouse chimeric antibody that binds and inactivates TNFα, an important proinflammatory cytokine. The chief adverse effect of TNFα blockers is the elevated risk of infections. One side effect is the new onset or acute exacerbation of psoriatic skin lesions [4,5,8,9,10,11,12,13,14,15]. In this article we present two cases of newly triggered psoriatic skin lesions in a patient with Crohn’s disease and a further patient with ankylosing spondylitis after treatment with the monoclonal anti-TNF-α antibody infliximab
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