Psoriasiform Reactions to Anti-Tumor Necrosis Factor α Therapy

Objective: Given increasing concern about the adverse effects of anti-tumor necrosis factor alpha (anti-TNF-alpha) medications, we sought to characterize psoriasiform eruptions in patients on these medications. Methods: In a retrospective review of patients at the Brigham and Women's Hospital combined dermatology-rheumatology clinic, we identified 13 patients (1 male and 12 female patients) who developed psoriasiform eruptions while on anti-TNF-alpha medications. Results: Inciting medications were adalimumab, etanercept, and infliximab. Patients were on their inciting medication for a median time of 24 months and a mean time of 31.3 months before developing eruptions. Five of 7 patients experienced complete resolution of lesions with topical corticosteroids and discontinuation of anti-TNF-alpha medications with the remaining 2 patients having partial improvement. One of the other 6 patients experienced complete resolution with topical corticosteroid treatment only, with the remaining 5 patients experiencing partial improvement. After changing anti-TNF-alpha agents, 1 patient had partial improvement of psoriasiform lesions, and 7 patients had no improvement. Conclusions: All of the main anti-TNF-alpha medications currently used are capable of causing psoriasiform eruptions. Poor responders to topical agents, such as corticosteroids, may benefit from supplemental therapy aimed at the psoriasiform eruption or changing to a different class of immunomodulatory agents. Switching anti-TNF-alpha medications had a low likelihood of improving psoriasiform skin reactions, further suggesting that these eruptions are a drug class effect.