TNF-α Blocker-Induced Psoriasiform Dermatitis

Background The anti-TNF-α agents adalimumab, infliximab and etanercept are indicated for a variety of autoimmune diseases such as rheumatoid arthritis (RA), Crohn's disease (CD), ankylosing spondylitis (AS), psoriatic arthritis (PsA) and psoriasis (Pso). In some patients treated for nonpsoriatic conditions such as rheumatoid arthritis and Crohn's disease, these agents have been associated with the appearance of psoriasis (either its emergence or exacerbation)—a term previously coined TNF-α antagonist induced psoriasis. Objective This article reviews published data demonstrating this phenomenon. Methods Studies with English abstracts between 2000–2008, identified in MEDLINE and PUBMED with keywords anti-TNF, psoriasis, TNF-α antagonist and induced, were retrospectively reviewed. Results An association between use of anti-TNF agents and the appearance of psoriasis was seen in a total of 219 patients from 38 reports. Conclusion There is an association between use of anti-TNF agents and appearance of psoriasis, but the specific nature of the relationship is unknown. Recent studies help to delineate patient characteristics common among the group, as well as theorize proposed mechanisms for the emergence of psoriasis. At this time, however, further investigation into this multi-factorial condition is needed.