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Background: Systemic immunomodulatory agents are indicated in the treatment of moderate-to-severe plaque psoriasis and psoriatic arthritis. Perioperative use of these medications may increase the risk of surgical site infection (SSI) and complication., Objective: To evaluate the risk of SSI and complication in patients with chronic autoimmune inflammatory disease receiving immunomodulatory agents (tumor necrosis factor-alfa [TNF-α] inhibitors, interleukin [IL] 12/23 inhibitor, IL-17 inhibitors, IL-23 inhibitors, cytotoxic T-lymphocyte-associated antigen-4 costimulator, phosphodiesterase-4 inhibitor, Janus kinase inhibitors, tyrosine kinase 2 inhibitor, cyclosporine (CsA), and methotrexate [MTX]) undergoing surgery., Methods: We performed a search of the MEDLINE PubMed database of patients with chronic autoimmune inflammatory disease on immune therapy undergoing surgery., Results: We examined 48 new or previously unreviewed studies; the majority were retrospective studies in patients with rheumatoid arthritis and inflammatory bowel disease., Conclusion: For low-risk procedures, TNF-α inhibitors, IL-17 inhibitors, IL-23 inhibitors, ustekinumab, abatacept, MTX, CsA, and apremilast can safely be continued. For intermediate- and high-risk surgery, MTX, CsA, apremilast, abatacept, IL-17 inhibitors, IL-23 inhibitors, and ustekinumab are likely safe to continue; however, a case-by-case approach is advised. Acitretin can be continued for any surgery. There is insufficient evidence to make firm recommendations on tofacitinib, upadacitinib, and deucravacitinib., Competing Interests: Conflicts of interest Dr Feldman has received research, speaking and/or consulting support from Eli Lilly and Company, GlaxoSmithKline/Stiefel, AbbVie, Janssen, Alvotech, vTv Therapeutics, Bristol Myers Squibb, Samsung, Pfizer, Boehringer Ingelheim, Amgen, Dermavant, Arcutis, Novartis, Novan, UCB, Helsinn, Sun Pharma, Almirall, Galderma, LEO Pharma, Mylan, Celgene, Ortho Dermatology, Menlo, Merck & Co, Qurient, Forte, Arena, Biocon, Accordant, Argenx, Sanofi, Regeneron, the National Biological Corporation, Caremark, Teladoc, BMS, Ono, Micreos, Eurofins, Informa, UpToDate, and the National Psoriasis Foundation and is a founder and part owner of Causa Research and holds stock in Sensal Health. Dr Wu is or has been an investigator, consultant, or speaker for AbbVie, Almirall, Amgen, Arcutis, Aristea Therapeutics, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Dermavant, DermTech, Dr. Reddy’s Laboratories, Eli Lilly, EPI Health, Galderma, Janssen, LEO Pharma, Mindera, Novartis, Pfizer, Regeneron, Samsung Bioepis, Sanofi Genzyme, Solius, Sun Pharmaceutical, UCB, and Zerigo Health. Dr Hsu has served on the advisory board for Boehringer Ingelheim, LEO Pharma, and Sanofi and has served on the registries/clinical trials for CorEvitas, PROSE, Argenx, and Cabaletta. Dr Armstrong has served as a research investigator, scientific adviser, and/or speaker to AbbVie, Almirall, Arcutis, ASLAN, Beiersdorf, BI, BMS, EPI, Incyte, Leo, UCB, Janssen, Lilly, Mindera, Nimbus, Novartis, Ortho Dermatologics, Sun, Dermavant, Dermira, Sanofi, Regeneron, and Pfizer. Dr Wallace has served as a research investigator, scientific adviser, and/or speaker to Pfizer, Target RWE, Kyowa, Amgen, Arcutis, and Argenx. Dr Lee has served as a research investigator, scientific adviser, and/or speaker to Eli Lilly, Sanofi, Regeneron, Pfizer, Trevi Therapeutics, AbbVie, Mayne Pharmaceuticals, Incyte Corp, Castle Creek, Pyramid Bioscience, Amyrt, Krystal Biotech, Arcutis, Celgene, Target Pharma, Amgen, Novartis, UCB, Galderma, Kiniksa, Avita, Janssen, MoonLake Pharmaceuticals, and Timber Pharmaceuticals. Dr Merola is a consultant and/or investigator for Amgen, Bristol Myers Squibb, AbbVie, Dermavant, Eli Lilly, Incyte, Novartis, Janssen, UCB, Sanofi Regeneron, Sun Pharma, Biogen, Pfizer, and LEO Pharma. Dr Schwartzman has served as a speaker and/or consultant to AbbVie, Janssen, Lilly, Pfizer, UCB, Myriad, Novartis, Sanofi/Regeneron, Stelexis, Jubilant, and Teijin and has served as a board member to the National Psoriasis Foundation. Dr Gladman has received consulting fees from AbbVie, Amgen, BMS, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, and UCB and has received research support from AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, and UCB. Dr Liu has served as a research investigator, scientific adviser, and/or speaker to for AbbVie, Janssen, Lilly, Sanofi Regeneron, Arcutis, Dermavant, Pfizer, Bristol Myers Squibb, UCB, Incyte, Amgen, and Evelo. Dr Koo has served on the advisory board/consultant for AbbVie, Arcutis, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Castle, Dermavant, Incyte, Janssen, Eli Lilly, EPI, Leo, Novartis, Ortho Dermatologics/Valeant, Pfizer, Regeneron/Sanofi, Sun Pharma, and UCB. Dr Hawkes has served on the advisory board/consultant for AbbVie, Arcutis, Boehringer Ingelheim, BMS, Janssen, LearnSkin, LEO, Lilly, Novartis, Pfizer, Regeneron-Sanofi Genzyme, and UCB, has served on the medical/scientific board for the National Psoriasis Foundation and International Psoriasis Council (IPC), and has stock ownership/equity in Regeneron Pharmaceuticals. Dr Reddy has served on the advisory board/consultant UCB, Novartis, Fresenius, Amgen, AbbVie, Janssen, and Pfizer. Dr Prussick has served as a scientific adviser and/or speaker to of Amgen, Janssen, AbbVie, and Novartis and has served as a board member to the National Psoriasis Foundation. Dr Yamauchi has served as a research investigator, scientific adviser, and/or speaker to AbbVie, Amgen, Lilly, Janssen, Sun Pharma, BMS, UCB, Ortho Dermatologics, and Novartis. Dr Lewitt has received grants/research support from Novan, Galderma, Leo, Lilly, DermTech, and Amgen and has served as a speaker’s bureau/consultant/advisory board for AbbVie, Janssen, Lilly, Galderma, Pfizer, UCB, Ortho Dermatologics, Dermavant, and Bristol Myers Squibb. Dr Soung has served as a research investigator, scientific adviser, and/or speaker to Celgene, Amgen, Eli Lilly, AbbVie, Pfizer, Ortho Dermatologics, National Psoriasis Foundation (non-profit), LEO, Novartis, Regeneron/Sanofi, UCB, Janssen, Kyowa Kirin, Dermavant, Bristol Myers Squibb, Arcutis, KoBioLabs, and Castle Biosciences. Dr Weinberg has served as a speaker for AbbVie, Dermavant, Lilly, Janssen, BMS, Amgen, and UCB and has received research grants from Arcutis, Dermavant, AbbVie, UCB, Janssen, and Lilly. Dr Lebwohl is an employee of Mount Sinai, has received research funds from AbbVie, Amgen, Arcutis, Avotres, Boehringer Ingelheim, Cara Therapeutics, Dermavant Sciences, Eli Lilly, Incyte, Inozyme, Janssen Research & Development, LLC, Novartis, Ortho Dermatologics, Regeneron, and UCB, Inc, and is a consultant for AnaptysBio, Arcutis, Inc, Arena Pharmaceuticals, Aristea Therapeutics, Avotres Therapeutics, BioMX, Boehringer Ingelheim, Brickell Biotech, Cara Therapeutics, Castle Biosciences, CorEvitas, Dermavant Sciences, Evommune, Inc, Facilitation of International Dermatology Education, Forte Biosciences, Foundation for Research and Education in Dermatology, Hexima Ltd, Incyte, Meiji Seika Pharma, Mindera, National Society of Cutaneous Medicine, New York College of Podiatric Medicine, Pfizer, Seanergy, SUN Pharma, Verrica, and Vial. Dr Glick has served as a research investigator, scientific adviser, and/or speaker to AbbVie, AstraZeneca, Amgen, Janssen, Galderma, Sun Pharma, LEO Pharma, Lilly, Novartis, Dermavant Sciences, Incyte, EPI/Novan, BMS, Nimbus Lakshmi, Cara Therapeutics, Dermira, Sanofi/Genzyme, Regeneron, Pfizer, ChemoCentryx, Ortho Dermatologics, UCB, Brickell, Biotech, CorEvitas Registry PSO, CorEvitas Registry AD, PROSE Registry for AD. Dr Kircik has served as a research investigator, scientific adviser, board member, and/or speaker to Abbott Laboratories, AbbVie, Allergan, Inc, Almirall, Amgen, Inc, Arcutis, Biogen-Idec, BMS, Boehringer Ingelheim, Breckinridge Pharma, Celgene, Centocor, Inc, Cellceutix, Cipher, Combinatrix, Connetics Corporation, Coria, Dermavant, Dermira, Dow Pharmaceutical Sciences, Inc, Dr. Reddy’s Laboratories, Eli Lilly, Galderma, Genentech, Inc, GlaxoSmithKline, PLC, Idera, Johnson & Johnson, Leo, Maruho, Merck, Medicis Pharmaceutical Corp, Novartis AG, Promius, PharmaDerm, Pfizer, Serono (Merck Serono International SA), Stiefel Laboratories, Inc, Sun Pharma, Taro, UCB, Valeant Pharmaceuticals Intl, and XenoPort. Dr Desai has served on the Medical Board of the National Psoriasis Foundation and holds multiple other leadership positions in dermatologic organizations, and has served as a researcher and/or consultant for Pfizer, Lilly, AbbVie, Bristol Myers Squibb, Galderma, and other organizations. Drs James and Zaino and Author Rosenberg have no conflicts of interest to declare., (Copyright © 2024 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Introduction. Previous studies suggest that one of the possible reasons of depression is the autoimmune inflammation that causes increased interleukin and cytokines levels and thus affects the mood and well-being. Aims. To compare depression and anxiety symptoms bei tween the patients with inflammatory bowel disease receiving tu-mor necrosis factor-alpha (TNF-a) inhibitor (adalimumab, infliximab) and the patients receiving different medical treat-ment. Methods. Quantitative cross-sectional study design was used. Instruments: Ulcerative colitis activity index, Crohn's disease activity index, the subscale of neurovegetative depression symp-toms of the Beck depression inventory, and Hospital anxiety and depression scale. Patients diagnosed with active ulcerative colitis or Chron's disease and not using antidepressants were included in the study. Participants were divided into an experimental group (receiving tumor necrosis factor-alpha inhibitors) and control group (receiving treatment with other drugs). Results. 46 patients' data were analysed. The disease activity index was not significantly different between the experimental group and the control group (Chron's disease 3.54 vs 4.20; ulcer-ative colitis 5.70 vs 5.00; p>0.05). The mean scores of neuroveg-etative depression symptoms subscale of the Beck depression in-ventory were not significantly different (2.52 experimental vs 3.91 control; p>0.05) between both groups. The mean score of the hospital anxiety and depression scale were significantly dif-ferent between both groups (5.22 vs 8.13; p<0.05), which indi-cates less depressive symptoms in the experimental group. The mean anxiety subscale scores were not significantly different (3.78 vs 5.48; p>0.05), while the mean depressive subscale score was significantly different in the conirol group (1.43 vs 2.65; p<0.05). Conclusions. Participants treated with tumor necrosis fac-tor-alpha inhibitor experienced fewer depression symptoms than participants showing similar disease activity, but receiving dif-ferent medical treatment. Depressive symptoms were affected more than anxiety symptoms in the group of inflammatory bowel disease patients. [ABSTRACT FROM AUTHOR]

Background: Paradoxical hidradenitis suppurativa (HS) induced by biologic agents (BA) is scarcely reported.Objective: We sought to describe the clinical characteristics and outcome of patients developing paradoxical HS under BA.Methods: This was a multicenter nationwide retrospective study asking physicians to report all cases of HS, confirmed by a dermatologist, occurring during treatment of an inflammatory disease by a BA.Results: We included 25 patients (15 inflammatory rheumatism, 9 Crohn's disease, 1 psoriasis) treated by 5 BA (adalimumab = 12, infliximab = 6, etanercept = 4, rituximab = 2, tocilizumab = 1). Median duration of BA exposure before HS onset was 12 (range 1-120) months. Patients were mostly Hurley stage I (n = 13) or II (n = 11). Simultaneously to HS or within 1 year, 11 patients developed additional inflammatory diseases, including paradoxical reactions (psoriasis = 9, Crohn's disease = 3, alopecia areata = 1, erythema elevatum diutinum = 1). Complete improvement of HS was more frequently obtained after BA discontinuation or switch (n = 6/10, 60%) rather than maintenance (n = 1/14, 7%). Reintroducing the same BA resulted in HS relapse in 3 of 3 patients.Limitations: Retrospective nature and lack of complete follow-up for some patients are limitations.Conclusion: HS is a rare paradoxical adverse effect of BA, but fortuitous association cannot be excluded in some cases. We observed a trend toward better outcome when the BA was discontinued or switched. [ABSTRACT FROM AUTHOR]

Background: Some studies have shown that switching patients from one tumor necrosis factor (TNF)-alfa inhibitor to another may be beneficial when they have an inadequate response or an adverse event., Objective: We sought to assess the variables predicting the efficacy of the second TNF-alfa inhibitor in patients discontinuing the first TNF-alfa inhibitor., Methods: Data from all 5423 consecutive patients starting TNF-alfa inhibitor therapy for psoriasis between September 2005 and September 2010 who were included in the Italian Psocare registry were analyzed., Results: In 105 patients who switched to a second TNF-alfa inhibitor who had complete follow-up data, 75% improvement in the Psoriasis Area Severity Index score (PASI 75) was reached by 29% after 16 weeks and by 45.6% after 24 weeks. Patients who switched because of secondary loss of efficacy (loss of initial PASI 75 response) or adverse events/intolerance were more likely to reach PASI 75 than those who switched as a result of primary inefficacy (PASI 75 never achieved) (hazard ratio 2.7, 95% confidence interval 1.3-5.5 vs hazard ratio 2.0, 95% confidence interval 1.0-3.9 and 1, respectively)., Limitations: There was a small number of patients with complete follow-up data., Conclusion: PASI 75 response in patients who switched from one anti-TNF-alfa agent to another was significantly reduced in patients who showed primary inefficacy of the first anti-TNF-alfa., (Copyright © 2013 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)