Original articleOnset or exacerbation of cutaneous psoriasis during TNFα antagonist therapy
Introduction
TNFα antagonists have been found effective in various rheumatic and nonrheumatic diseases. The increasing use of these agents has led to the recognition of several paradoxical adverse effects. One example is the new onset or exacerbation of cutaneous psoriasis. TNFα antagonists are effective in treating psoriasis and are licensed for use in patients with severe forms of the disease. We retrospectively identified 12 cases of psoriasis onset or exacerbation during TNFα antagonist therapy.
Section snippets
Methods
We conducted a retrospective observational study of patients with new onset or exacerbation of cutaneous psoriasis during treatment with TNFα antagonists for a variety of diseases. All the patients were evaluated at our hospital departments.
For each patient, we recorded the following data: age, sex, underlying disease with its duration, time from TNFα antagonist initiation to psoriasis onset or exacerbation, type and dosage of the TNFα antagonist, concomitant treatments, previous history of
Results
We identified 12 patients, whose main characteristics are shown in Table 1. There were six women and six men, with a mean age of 45.5 years. Of the 12 patients, six were taking etanercept, four adalimumab, and two infliximab. The drugs were used in standard dosages. The underlying disease was ankylosing spondylitis or another spondyloarthropathy in six patients, rheumatoid arthritis in four patients, and psoriatic arthritis in two patients. A previous history of psoriasis was noted in six
Discussion
We report on 12 cases of psoriasis onset or exacerbation during TNFα antagonist therapy for a variety of diseases. Three different TNFα antagonists were involved.
This side effect may seem paradoxical, given that TNFα antagonists are used to treat severe forms of psoriasis. About 40 similar cases have been reported in the medical literature [1], [2], [3], [4], [5], [6], [7], [8], [9], [10]. Psoriasis occurred during six of 400 TNFα antagonist treatments at a rheumatology center [2] and in five
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