Fundacion Hospital La Fe, Hospital Universitari La Fe, Spain.
J Crohns Colitis. 2011 Apr;5(2):157-61. doi: 10.1016/j.crohns.2010.11.001. Epub 2010 Dec 7.
Treatment with antitumor necrosis factor-alpha (anti-TNF-α) offers a significant improvement in several immune-based diseases, including Crohn's disease (CD) and psoriasis. Different cutaneous side effects have been described for anti-TNF-α therapy such as psoriasis. Previous reports showed that inhibition of TNF-α can induce over expression of cutaneous IFN-α, which in turn caused a predisposition to psoriasis. We report a 31-year-old woman with extensive CD and perianal lesions, without response to conventional treatment. She paradoxically developed a cutaneous eruption with psoriasiform morphology and distribution during treatment with both anti-TNF-α approved in Europe for CD, infliximab and adalimumab. These lesions cleared after topical application of corticosteroids and cessation of the anti-TNF-α treatment. Due to uneffectiveness of pharmacological treatment on disease, the patient had to undergo surgery. TNF-induced psoriasis in patients with CD is rare and has been previously documented with infliximab or adalimumab. The reason for this apparently paradoxical effect of the therapy is still unclear. This is the first case of psoriasis induced first by infliximab and later by adalimumab in the same CD patient. We would like to review and to draw attention about psoriasis as a cutaneous side effect with anti-TNF-α treatments.
抗肿瘤坏死因子-α(anti-TNF-α)治疗为包括克罗恩病(CD)和银屑病在内的几种免疫性疾病提供了显著改善。抗 TNF-α治疗有不同的皮肤副作用,如银屑病。先前的报告显示,TNF-α的抑制可以诱导皮肤 IFN-α的过度表达,进而导致银屑病易感性。我们报告了一位 31 岁的女性,患有广泛的 CD 和肛周病变,对常规治疗无反应。她在接受欧洲批准用于 CD 的两种抗 TNF-α药物(英夫利昔单抗和阿达木单抗)治疗时,出现了一种具有银屑病形态和分布的皮肤疹,这种皮疹具有矛盾性。这些病变在局部应用皮质类固醇和停止抗 TNF-α治疗后消退。由于药物治疗对疾病无效,患者不得不接受手术。CD 患者中 TNF 诱导的银屑病很少见,此前曾有英夫利昔单抗或阿达木单抗的报道。这种治疗的明显矛盾作用的原因尚不清楚。这是首例在同一 CD 患者中,首先由英夫利昔单抗引起,随后由阿达木单抗引起的银屑病病例。我们希望回顾并引起对 TNF-α治疗的皮肤副作用——银屑病的关注。