Abstract
The tumor necrosis factor alpha (TNFα) inhibitors have been used with good clinical results in the treatment of juvenile idiopathic arthritis (JIA). Anti TNFα therapy is generally well tolerated. Besides the site injection reactions, other various cutaneous manifestations have been encountered as adverse events. Here, we report four young patients receiving treatment with anti-TNFα (infliximab, adalimumab, and etanercept) for JIA developing different skin manifestations more than 1 year after the initiation of therapy. They underwent a dermatological exam. All four patients were ACR-Ped 30 responders to anti-TNF drugs. The first patient developed cutaneous vasculitis, the second one had lichen planus manifestations, while the third and the fourth developed psoriatic palmoplantar pustulosis accompanied by plaque-type psoriasis localized to the scalp. None of the patients had a personal or family history of dermatological diseases. In the first two patients, skin lesions healed with topical treatment after the discontinuation of anti-TNF agent, while psoriatic lesions did not resolve despite discontinuation of the drug and dermatological treatment. TNF inhibition can be both anti-inflammatory and pro-inflammatory. Cutaneous manifestations could be considered as a paradoxical adverse event of the anti-TNF-alpha treatment not only in rheumatoid arthritis but also in juvenile idiopathic arthritis.
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References
Mease P (2004) TNF-α therapy in psoriatic arthritis and psoriasis. Ann Rheum Dis 63:755–758
Winterfield LS, Menter A, Gordon K, Gottlieb A (2005) Psoriasis treatment: current and emerging directed therapies. Ann Rheum Dis 64(Suppl 2):87–90
Sfikakis PP, Kollias G (2003) Tumor necrosis factor biology in experimental and clinical arthritis. Curr Opin Rheumatol 15:380–386
Ramos-Casals M, Brito-Zerón P, Muñoz S, Soria N, Galiana D, Bertolaccini L, Cuadrado MJ, Khamashta MA (2007) Autoimmune diseases induced by TNF-targeted therapies: analysis of 233 cases. Medicine (Baltimore) 86:242–251
Cohen JD, Bournerias I, Buffard V, Paufler A, Chevalier X, Bagot M, Claudepierre P (2007) Psoriasis induced by tumor necrosis factor-alpha antagonist therapy: a case series. J Rheumatol 34:380–385
Sfikakis PP, Iliopoulos A, Elezoglou A, Kittas C, Stratigos A (2005) Psoriasis induced by anti-tumor necrosis factor therapy: a paradoxical adverse reaction. Arthritis Rheum 52:2513–2518
Saint Marcoux B, De Bandt M, CRI (Club Rhumatismes et Inflammation) (2006) Vasculitides indiced by TNFalpha antagonists: a study in 39 patients in France. Joint Bone Spine 73:710–713
Roux CH, Brocq O, Leccia N, Giacchero D, Breuil V, Albert C, Lacour J, Perrin C, Euller-Ziegler L (2007) New-onset psoriatic palmoplantaris pustulosis following infliximab therapy: a class effectα. J Rheumatol 34:434–437
Kary S, Worm M, Audring H, Huscher D, Renelt M, Sörensen H, Ständer E, Maass U, Lee H, Sterry W, Burmester GR (2006) New onset or exacerbation of psoriatic skin lesions in patients with definite rheumatoid arthritis receiving tumour necrosis factor alpha antagonists. Ann Rheum Dis 65:405–407
Carter JD, Gerard HC, Hudson AP (2008) Psoriasiform lesions induced by tumour necrosis factor antagonists: a skin-deep medical conundrum. Ann Rheum Dis 67:1181–1183
Takahashi H, Hashimoto Y, Ishida-Yamamoto A, Ashida T, Kohgo Y, Iizuka H (2007) Psoriasiform and pustular eruption induced by infliximab. J Dermatol 34:468–472
Collamer AN, Guerrero KT, Henning JS, Battafarano DF (2008) Psoriatic skin lesions induced by tumor necrosis factor antagonist therapy: a literature review and potential mechanisms of action. Arthritis Rheum 59:996–1001
Kolarz B, Targoαska-Stepniak B, Darmochwaα-Kolarz D, Majdan M (2007) Autoimmune aspects of treatment with TNF-alpha inhibitors. Postepy Hig Med Dosw (Online) 61:478–484, Review. Polish
Markham T, Mullan R, Golden-Mason L, Rogers S, Bresnihan B, Fitzgerald O, Fearon U, Veale DJ (2006) Resolution of endothelial activation and down-regulation of Tie2 receptor in psoriatic skin after infliximab therapy. J Am Acad Dermatol 54:1003–1012
Aslanidis S, Pyrpasopoulou A, Douma S, Triantafyllou A (2008) Tumor necrosis factor-a antagonist-induced psoriasis: yet another paradox in medicine. Clin Rheumatol 27:377–380
De Gannes GC, Ghoreishi M, Pope J, Russell A, Bell D, Adams S, Shojania K, Martinka M, Dutz JP (2007) Psoriasis and pustular dermatitis triggered by TNF-{alpha} inhibitors in patients with rheumatologic conditions. Arch Dermatol 143:223–231
Davaine AC, Saraux A, Prigent S, Kupfer-Bessaguet I, Roswag D, Plantin P, Schoenlaub P, Talarmin F, Zagnoli A, Misery L (2008) Cutaneous events during treatment of chronic inflammatory joint disorders with anti-tumour necrosis factor alpha: a cross-sectional study. J Eur Acad Dermatol Venereol 22:1471–1477
Beuthien W, Mellinghoff HU, von Kempis J (2004) Skin reaction to adalimumab. Arthritis Rheum 50:1690–1692
Fiorentino DF (2007) The Yin and Yang of TNF-{alpha}inhibition. Arch Dermatol 143:233–236
Calabrese L (2006) The yin and yang of tumor necrosis factor inhibitors. Cleve Clin J Med 73:251–256
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Pontikaki, I., Shahi, E., Frasin, L.A. et al. Skin Manifestations Induced by TNF-Alpha Inhibitors in Juvenile Idiopathic Arthritis. Clinic Rev Allerg Immunol 42, 131–134 (2012). https://doi.org/10.1007/s12016-011-8262-2
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DOI: https://doi.org/10.1007/s12016-011-8262-2