INTRODUCTION: Anti-tumor necrosis factor alpha agents (anti-TNFs) have been widely used for the treatment of inflammatory bowel disease (IBD). There is a paradoxical risk of skin reactions for patients (pts) on anti-TNFs. Here, we describe our experience with IBD pts who developed dermatologic (derm) adverse events (AEs) on anti-TNFs. METHODS: We retrospectively reviewed 746 charts in an established database of IBD pts to identify pts with anti-TNF induced psoriasis (PsO) or eczema between 11/1/2016 and 2/28/2019. Medical records were reviewed to obtain the following information: baseline demographics, medication use including anti-TNFs and immunomodulators, treatment of derm conditions, and whether pts were continued on anti-TNFs. RESULTS: 520 pts (58% female, median age was 23 years [range 2-77]) were exposed to anti-TNF therapy, and 14 pts (2.6%) with derm AEs were identified. Among the 14 pts with skin reactions 13/14 had PsO and 1/14 had eczema. Please see Table 1 for additional baseline demographics. The average time from anti-TNF initiation to derm AEs was 17.1 months. Eleven pts (78.6%) received treatment such as topical or systemic steroids for their skin reaction. Six pts developed a skin reaction on infliximab (IFX) and 8 pts on adalimumab (ADA). Five pts continued on the same therapy and 8 pts stopped the current therapy or switched to a different class of therapy. Interestingly, 1 pt changed to another anti-TNF therapy and did not develop dermatologic AEs. Six pts were current smokers or had a history of smoking. None had family history of psoriasis. IFX use (OR = 0.34 [95% CI 0.10-1.13], P = 0.04) was associated with a decreased likelihood of derm AEs. ADA use (OR = 0.79 [95% CI 0.24-2.80], P = 0.66) and history of or current smoking (OR = 1.27 [95% CI 0.36-4.24], P = 0.66) were not associated with increased risk of anti-TNF induced psoriasis (Table 2). Seven out of 14 (50%) of pts had anti-TNF level drawn and all were detectable; 1 out of 7 pts had antibodies to anti-TNF. CONCLUSION: In our cohort, there was a low frequency of derm AEs associated with anti-TNFs. Eight out of 14 pts (57%) who developed derm AEs were switched to a different class of IBD medications. Neither use of ADA nor smoking history increased risk for adverse skin reactions while IFX use was less likely to be associated with derm AEs. Future directions include identifying additional risk factors for development of adverse skin reactions and to assess whether there is any correlation with drug levels.Table 1Table 2