Digestive Diseases Department, Hospital de Fuenlabrada, Spain.
J Crohns Colitis. 2012 Jun;6(5):518-23. doi: 10.1016/j.crohns.2011.10.007. Epub 2011 Nov 13.
Anti-tumor necrosis factor (TNF)-alpha agents are widely used for the treatment of both inflammatory bowel disease (IBD) and psoriasis. Psoriatic skin lesions induced by anti-TNF have been described in patients with IBD. We report a case series of psoriasis induced by anti-TNF agents in IBD patients.
Systematic analysis of cases of psoriasis induced by anti-TNF in an IBD patient cohort in tertiary hospitals of Madrid.
A total of 21 of 1294 patients with IBD treated with anti-TNF-alpha agents developed drug-induced psoriasis (cumulative incidence 1.62%; 95% CI 1.06%-2.47%): 14 patients with infliximab and 7 with adalimumab; seventeen with Crohn's disease, 4 with ulcerative colitis. The onset of skin lesions varied in a wide range of time (after a mean 13±8 doses). The most frequent site of skin lesions was the limbs (62%) followed by the trunk (48%) and the scalp (43%). The psoriasis phenotypes were plaque psoriasis (57%), scalp (14%), palmoplantar pustulosis (14%), pustular generalized psoriasis (5%), guttate (5%) and inverse (5%). Four patients interrupted the anti-TNF treatment, and that led to the complete regression of lesions in 1 of them. The other 17 patients were maintained on anti-TNF therapy and managed with topical steroids.
Psoriatic lesions can be induced by anti-TNF drugs. Plaque psoriasis on the extremities and trunk were the most frequent presentations in our series. Topical steroid treatment is effective in most patients. Anti-TNF discontinuance may be reserved for patients with severe psoriasis or patients without response to topical therapy.
抗肿瘤坏死因子（TNF）-α 制剂广泛用于治疗炎症性肠病（IBD）和银屑病。在 IBD 患者中，已描述了抗 TNF 引起的银屑病皮肤病变。我们报告了一组在 IBD 患者中由抗 TNF 制剂引起的银屑病病例系列。
在马德里的三家医院对接受抗 TNF-α 治疗的 IBD 患者队列中的银屑病诱导病例进行系统分析。
在接受抗 TNF-α 治疗的 1294 例 IBD 患者中，共有 21 例（累积发生率 1.62%；95%CI 1.06%-2.47%）发生药物诱导性银屑病：14 例使用英夫利昔单抗，7 例使用阿达木单抗；17 例克罗恩病，4 例溃疡性结肠炎。皮肤病变的发病时间范围很广（平均 13±8 剂量后）。皮肤病变最常见的部位是四肢（62%），其次是躯干（48%）和头皮（43%）。银屑病表型为斑块状银屑病（57%）、头皮（14%）、掌跖脓疱病（14%）、泛发性脓疱性银屑病（5%）、点滴状（5%）和反向（5%）。有 4 名患者中断了抗 TNF 治疗，其中 1 名患者的病变完全消退。其余 17 名患者继续接受抗 TNF 治疗，并接受局部类固醇治疗。
抗 TNF 药物可引起银屑病病变。在我们的系列中，四肢和躯干的斑块状银屑病是最常见的表现。局部类固醇治疗对大多数患者有效。对于严重银屑病或对局部治疗无反应的患者，可能需要停用抗 TNF。
