Atopic Dermatitis: a Short Summary
- Infliximab is an anti-TNF biologic
- It is used in the treatment of rheumatoid arthritis, psoriasis and inflammatory bowel disease
A case report from Spain:
- 32 year old female known for Crohn’s disease
- no response to mesalazine and systemic corticosteroids
- was subsequently put on infliximab at a dosage 5mg/kg for a duration of 10 years
- she developed severe psoriasiform plaques covering entire scalp accompanied with alopecia
- biopsy confirmed diagnosis of psoriasis
- The patient improved with topical steroids, vitamin D analogues and methotrexate 15mg subcutaneously weekly. Anti-TNF treatment was stopped.
Discussion
- there are currently over 200 cases of suspected TNF antagonist induced or exacerbated cases of psoriasis in the literature.
- In this case, reactivation was after 10 years of treatment. The cause is unknown but on suggested mechanisms include:
- the activation of nascent autoreactive T-cells
- disruption in cytokine balance by TNF blockade, allowing unopposed interferon-alpha production by plasmacytoid dendritic cells in genetically predisposed individuals
- there are currently no guidelines on how to change treatments in this situation.
Contributors
Dr Christophe Hsu – dermatologist. Geneva, Switzerland
Source of information: p317 Development of severe scalp psoriasis and alopecia during treatment of Crohn’s disease with infliximab: a paradoxical side effect. Martinez Peinado C. et al. EADV Annual Meeting (2014), Amsterdam The Netherlands
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