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Oh, Koh, Kim, Lee, Ahn, Cha, Lee, and Jang: Exacerbation of Psoriatic Skin Lesion followed by TNF-α Antagonist Treatment
Original Article

J Korean Rheum Assoc 2010;17(2):200-204.

Published online: 23 June 2010

DOI: https://doi.org/10.4078/jkra.2010.17.2.200

Exacerbation of Psoriatic Skin Lesion followed by TNF-α Antagonist Treatment

Ji-Min Oh1, Eun-Mi Koh1, Hyungjin Kim1, Jaejoon Lee1, Joong Kyong Ahn1, Hoon-Suk Cha1, Joo Heung Lee2, Kee Taek Jang3

1Divisions of Rheumatology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea

2Divisions of Rheumatology Dermatology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea

3Divisions of Rheumatology and Pathology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea

Received 7 September 20106 January 2010       Accepted 7 January 2010

Copyright © 2010 The Korean Rheumatism Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

TNF-α antagonists have been successfully utilized in the treatment of autoimmune diseases, including psoriasis and psoriatic arthritis. Paradoxically, new onset or exacerbation of psoriatic lesions during treatment with TNF-α antagonists have been reported. It has been postulated that TNF-α blockade may cause disruption in the balance between TNF-α and type 1 interferon (IFN)-α, which are the key players in the pathogenesis of psoriasis. We report a case of psoriasis exacerbation during TNF-α antagonist therapy in a 53-years-old man with ankylosing spondylitis. The patient has been treated with etanercept for 3 years and 7 months when he developed accelerated deterioration of psoriasis. His condition was previously under control solely by local treatment. Physical examination revealed vigorous desquamative lesions with silvery scale in both lower legs. Deterioration of psoriasis was attributed to etanercept therapy and was subsequently discontinued. Clinical improvement of psoriasis has been observed 2 months following cessation of etanercept.

Keywords: Psoriasis, TNF-α antagonists, Ankylosing spondylitis

REFERENCES

1). Kyle S., Chandler D., Griffiths CEM., Helliwell P., Lewis J., McInnes I, et al. Guideline for anti-TNF-a therapy in psoriatic arthritis. Rheumatology (Oxford). 2005. 44:390–7.
2). Harrison MJ., Dixon WG., Watson KD., King Y., Groves R., Hyrich KL, et al. Rates of new-onset psoriasis in patients with rheumatoid arthritis receiving anti-tumour necrosis factor a therapy: results from the British Society for Rheumatology Biologics Register. Ann Rheum Dis. 2009. 68:209–15.
3). Choi YJ., Kim DS., Park JM., Oh SH., Park YK., Lee JH. A case of psoriasiform eruption triggered by tumor necrosis factor-alpha antagonist therapy. Korean J Dermatol. 2008. 46:721–3.
4). Palucka AK., Blanck JP., Bennett L., Pascual V., Banchereau J. Cross-regulation of TNF and IFN-a in autoimmune diseases. Proc Natl Acad Sci USA. 2005. 102:3372–7.
5). Feldmann M., Brennan FM., Williams RO., Woody JN., Maini RN. The transfer of a laboratory based hypothesis to a clinically useful therapy: the development of anti-TNF therapy of rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2004. 18:59–80.
crossref
6). Leombruno JP., Einarson TR., Keystone EC. The safety of anti-tumor necrosis factor adverse events exposure-adjusted pooled analyses of serious treatments in rheumatoid arthritis. Ann Rheum Dis. 2009. ;68;1136-45.
7). Sari I., Akar S., Birlik M., Sis B., Onen F., Akkoc N. Anti-tumor necrosis factor-alpha-induced psoriasis. J Rheumatol. 2006. 33:1411–4.
8). Angelique NC., Karen TG., Jeffery SH., Daniel FB. Psoriatic skin lesions induced by tumor necrosis factor antagonist therapy: a literature review and potential mechanisms of action. Arthritis Rheum. 2008. 59:996–1001.
crossref
9). Rashmi R., Rao KS., Basavaraj KH. A comprehensive review of biomarkers in psoriasis. Clin Exp Dermatol. 2009. 34:658–63.
crossref
10). Sfikakis PP., Iliopoulos A., Elezoglou A., Kittas C., Stratigos A. Psoriasis induced by anti-tumor necrosis factor therapy: a paradoxical adverse reaction. Arthritis Rheum. 2005. 52:2513–8.
crossref
11). Kary S., Worm M., Audring H., Huscher D., Renelt M., Sorensen H, et al. New onset or exacerbation of psoriatic skin lesions in patients with definite rheumatoid arthritis receiving tumour necrosis factor a antagonists. Ann Rheum Dis. 2006. 65:405–7.
12). Jean DC., Irina B., Valerie B., Agnes P., Xavier C., Mrtine B, et al. Psoriasis induced by tumor necrosis factor-a antagonist therapy: a case series. J Rheumatol. 2007. 34:380–5.
13). Spyros A., Athina P., Stella D., Areti T. Tumor necrosis factor-a antagonist-induced psoriasis: yet another paradox in medicine. Clin Rheumatol. 2008. 27:377–80.
crossref
14). Wendling D., Balblanc JC., BriancLon D., Brousse A., Lohse A., Deprez P, et al. Onset or exacerbation of cutaneous psoriasis during TNFalpha antagonist therapy. Joint Bone Spine. 2008. 75:315–8.
15). Uwe W., Gesina H., Andre K., Jaqueline S., Erich K., Gunter H. Tumor necrosis factor-aL inhibitor-induced psoriasis or psoriasiform exanthemata. Am J Clin Dermatol. 2008. 9:1–14.
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