Hilewitz Daniel, Yacobovitz Sharon, Reiss-Huss Shiran, Matar Manar, Weintraub Yael, Shouval Dror S, Pavlovsky Lev, Friedland Rivka
School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
Clin Exp Dermatol. 2025 Feb 24;50(3):558-563. doi: 10.1093/ced/llae432.
Tumour necrosis factor α (TNF-α) inhibitor (TNFi)-induced psoriasiform eruptions are a well-known phenomenon among adults. However, data are limited regarding this reaction in children.
To describe in paediatric patients with inflammatory bowel disease (IBD) the clinical characteristics of TNFi-induced psoriasiform eruptions and the outcomes of various therapeutic options.
We reviewed the medical charts of paediatric patients (aged < 18 years) with IBD who developed TNFi-induced psoriasiform eruptions during 2006-2022.
Among 454 patients with IBD treated with TNFis, 58 (12.8%) were diagnosed with TNFi-induced psoriasiform eruptions, of whom 51 were included in the study. The female to male ratio was 1 : 1.3. The median age at skin eruption was 14.11 [interquartile range (IQR) 12.11-16.05] years. The median elapsed time to eruption appearance was 15.00 months (IQR 7.00-24.00) after initiation of the treatment. All 51 patients were treated with topical steroids and 17 (33%) needed systemic treatment (phototherapy, methotrexate or acitretin). Sixteen of 51 patients (31%) needed to stop TNFi treatment because of an intractable eruption. Female patients, patients with inflammatory alopecia and patients who were treated with methotrexate or phototherapy were more prone to stop TNFis.
TNFi-induced psoriasiform eruptions are common in paediatric patients with IBD. The eruption may appear months or even years after treatment initiation. Almost one-third of the described patients had to replace their treatment because of a recalcitrant cutaneous eruption. This indicates that a multidisciplinary approach is required.
肿瘤坏死因子α（TNF-α）抑制剂（TNFi）诱发的银屑病样皮疹在成人中是一种众所周知的现象。然而，关于儿童这种反应的数据有限。
描述炎症性肠病（IBD）儿科患者中TNFi诱发的银屑病样皮疹的临床特征以及各种治疗选择的结果。
我们回顾了2006年至2022年期间患有IBD且发生TNFi诱发的银屑病样皮疹的儿科患者（年龄<18岁）的病历。
在454例接受TNFi治疗的IBD患者中，58例（12.8%）被诊断为TNFi诱发的银屑病样皮疹，其中51例纳入研究。男女比例为1∶1.3。皮疹出现时的中位年龄为14.11岁[四分位间距（IQR）12.11 - 16.05]。治疗开始后皮疹出现的中位间隔时间为15.00个月（IQR 7.00 - 24.00）。所有51例患者均接受了外用糖皮质激素治疗，17例（33%）需要系统治疗（光疗、甲氨蝶呤或阿维A）。51例患者中有16例（31%）因皮疹难以控制而需要停用TNFi治疗。女性患者、有炎症性脱发的患者以及接受甲氨蝶呤或光疗的患者更倾向于停用TNFi。
TNFi诱发的银屑病样皮疹在IBD儿科患者中很常见。皮疹可能在治疗开始数月甚至数年后出现。近三分之一的所述患者因顽固性皮肤皮疹而不得不更换治疗方案。这表明需要采取多学科方法。
