Clinical management of Anti-TNF-alpha-induced psoriasis or psoriasiform lesions in inflammatory bowel disease patients: a systematic review

• Type: Another Publication in an International Scientific Journal
• Date: 2018

Authors

Melo, FJ (Author) Other; magina, s (Author) FMUP

Journal

Title: International Journal of Dermatology

Vol. 57

Pages: 1521-1532

ISSN: 0011-9059

Publisher: Wiley-Blackwell

Indexing

ISI Web of Knowledge - 14 Citations

Other information

Authenticus ID: P-00P-WNQ

DOI: 10.1111/ijd.14072

Abstract (EN): Tumor necrosis factor alpha inhibitors (anti-TNF-alpha) completely revolutionized the treatment of inflammatory bowel disease (IBD). However, anti-TNF-alpha-induced cutaneous side effects have been increasingly reported in the literature. Particularly, psoriasis and the recently recognized psoriasiform lesions are of particular concern, as anti-TNF-alpha agents are also used in the treatment of psoriasis, seemingly reflecting an immunological paradox. The clinical management of these cutaneous lesions is particularly challenging, owing to the potential need of anti-TNF-alpha discontinuation and scarcity of other therapeutic options. Therefore, optimization of current topical and systemic therapies and incorporation of new therapeutic agents is of great interest. Our aim is to review data in the literature regarding the clinical management of these cutaneous lesions and provide a therapeutic algorithm, supported by our experience as a tertiary referral center for IBD. Although in older reports no distinction was made, anti-TNF-alpha-induced psoriasiform lesions are not only more prevalent but also bear notable differences from classical psoriasis, possibly reflecting a different nosological entity. Onset of lesions has been related to periods of IBD remission, as supported by low levels of fecal calprotectin. Psoriasiform lesions can be adequately managed either by topical (glucocorticoids, calcineurin inhibitors, and antibiotics) or systemic (phototherapy, acitretin, glucocorticoids, and antibiotics) therapies and/or switch to other anti-TNF-alpha agents. Data referring to patients who were able to continue on the same IBD therapy ranged from 30.7 to 100%, reinforcing the importance of an adequate control of these lesions. The recently approved ustekinumab offers another step in the management of anti-TNF-alpha-intolerant patients.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 12