Vol.22 No.5

Original Article

Tumor necrosis factor-alpha antagonist therapy-induced psoriasis in Turkey: analysis of 514 patients

Authors

Ediz Dalkilic1,5 , Emel Bulbul Baskan2 , Nihan Alkis3 , Mustafa Gullulu4 , Mahmut Yavuz4 , Kamil Dilek4 , Alpaslan Ersoy4 , Mustafa Yurtkuran4

  • Division of Rheumatology, Department of Internal Medicine, Uludag Medical Faculty, Uludag University, Bursa, Turkey
  • Department of Dermatology, Uludag Medical Faculty, Uludag University, Bursa, Turkey
  • Department of Internal Medicine, Uludag Medical Faculty, Uludag University, Bursa, Turkey
  • Division of Nephrology, Department of Internal Medicine, Uludag Medical Faculty, Uludag University, Bursa, Turkey
  • Bademli mah., Eğitim cad., Gümüşköy sitesi, 24/20 Mudanya, Bursa, Turkey
Received:

4 July 2011

Accepted:

22 December 2011

Published online:

15 February 2012

Full Text

PDF　(member's only)

Abstract

Objectives New adverse events are being reported with the increased use of anti-tumor necrosis factor (TNF) α therapy. We studied cases of anti-TNFα-induced psoriasis observed in our pool of 514 patients receiving anti-TNFα treatment in Turkey.
Methods Three rheumatoid arthritis patients and 3 ankylosing spondylitis patients with anti-TNFα-induced psoriasis were included in the study. All patients were examined by a dermatologist, and 3 patients underwent skin biopsy.
Results None of the 6 patients had preexisting psoriasis or a familial history of psoriasis. The earliest and latest occurrences of psoriatic lesions were at the 6th week and 44th month of anti-TNFα therapy, respectively. Psoriasis was severe and refractory in two patients (requiring systemic treatment), while it presented as mild in four patients. Anti-TNFα therapy was totally withdrawn in case 1. In case 2, the treatment was halted for 3 months then switched to another TNFα blocker, and case 3 was switched to another anti-TNFα treatment. The treatment was sustained in the other 3 patients (cases 4, 5, and 6).
Conclusions TNFα blockers are very effective agents in the treatment of psoriasis, but it is interesting that the same molecules can, paradoxically, induce psoriasis. The occurrence of anti-TNFα-induced psoriasis in six out of 514 patients suggests that the incidence of this adverse reaction is, in fact, as not low as presumed in the literature. In some cases, a severe course of psoriasis may limit the use of these agents.

Key words

Drug-induced psoriasis - Rheumatoid arthritis - Spondyloarthropathy - Tumor necrosis factor α antagonist