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Recurring and intense skin lesions cause one-third of patients that take anti-tumor necrosis factor (TNF) therapy for inflammatory bowel disease (IBD) to discontinue treatment, reports Jean–François Rahier et al. in the December issue of Clinical Gastroenterology and Hepatology.

Anti-TNF agents are used to treat patients with a variety of immune disorders, including IBDs such as Crohn’s disease and ulcerative colitis. These drugs are generally safe, although a small percentage of patients develop infections or lymphoproliferative diseases. There have been recent reports of skin lesions—such as eczema and psoriasis—in patients on anti-TNF therapy.

Rahier et al. followed 85 patients with IBD that developed new or exacerbated eczema or psoriasis during treatment with anti-TNF agents. The skin lesions occurred in 60 patients who took infliximab, 20 who took adalimumab, and 5 who took certolizumab; 62 patients developed psoriasis and 23 developed eczema. The most frequently affected areas were the scalp, flexures, and face.

Palmo-plantar pustulosis induced by adalimumab.

The authors observed the skin lesions most frequently in women or people with a family history of psoriasis or atopy. The anti-TNF therapies had to be discontinued in 40% of patients with psoriasis and 17% with eczema, despite attempts to treat the skin problem with topical corticosteroids, keratolytics, emollients, or vitamin D analogues. The incidence rate of new onset psoriasis in patients treated with anti-TNF is estimated to be around 1.04 per 1000 person-years.

It is not clear how inhibition of TNF might lead to skin lesions. TNF prevents maturation of plasmacytoid dendritic cells, which produce interferon-a and infiltrate the skin of patients with psoriasis. Blocking TNF might allow unregulated production of interferon-a by these cells and lead to inflammation; increased expression of interferon-a has been reported in the dermal vasculature of patients who received anti-TNF therapy.

Rahier et al. conclude that psoriasiform and eczematiform skin lesions are a significant side effect of anti-TNF therapies. Because the most severe forms can cause patients to stop taking the drugs, these lesions need to be carefully managed with the help of a dermatologist.

Further Reading on Anti-TNF Therapy for IBD:

Read the article online:
Rahier J–F, Buche S, Peyrin–Biroulet L, et al. Severe skin lesions cause patients with inflammatory bowel disease to discontinue anti–tumor necrosis factor therapy. Clin Gastroenterol and Hepatol 2010;8:1048–1055.

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Dr. Kristine Novak

Dr. Kristine Novak

Dr. Kristine Novak is a science writer and editor based in San Francisco. She has extensive experience covering gastroenterology, hepatology, immunology, oncology, clinical, and biotechnology research discoveries.

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