RESEARCH - Psoriasiform lesions induced by TNF antagonists: a skin-deep medical conundrum

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Ann Rheum Dis. 2008 Aug;67(8):1181-3. Epub 2008 Feb 25.

Psoriasiform lesions induced by tumour necrosis factor antagonists: a

skin-deep medical conundrum.

JD, Gerard HC, Hudson AP.

Department of Internal Medicine, Division of Rheumatology, University

of South Florida School of Medicine, 12901 Bruce B Downs Blvd MDC81,

Tampa, Florida 33612, USA.

Rarely, tumour necrosis factor (TNF)alpha antagonist therapy has been

associated with de novo psoriasiform eruptions. This is unusual in

that these same drugs are used to treat psoriasis. Most of these cases

involve the palms and soles, yet palmoplantar pustular psoriasis

represents only 1.7% of all cases of psoriasis. Keratoderma

blenorrhagicum is a psoriasiform rash that occurs primarily on the

palms and soles of some patients with reactive arthritis. It is

grossly and histologically indistinguishable from pustular psoriasis.

Chlamydia trachomatis is a common aetiological agent for reactive

arthritis, and in vitro studies have shown that chlamydial replication

is inversely proportional to TNFalpha levels. Three patients taking

TNFalpha antagonists are presented who developed such lesions and who

were found to be positive for C trachomatis DNA in the affected skin.

It is proposed that these psoriasiform lesions may not be psoriasis,

but rather keratoderma blenorrhagicum.

http://www.ncbi.nlm.nih.gov/pubmed/18299302

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Not an MD