Background

Tumor necrosis factor-α (TNF-α) inhibitor (TNFI)-induced psoriasis remains poorly understood despite having been described 15 years ago. As TNFIs often provide life-changing patient benefits, understanding effective treatments for TNFI-induced psoriasis is important.

Objective

We characterized a cohort of patients with TNFI-induced psoriasis whose psoriasis was specifically diagnosed and managed or comanaged by dermatologists at a single tertiary care institution over a 10-year period.

Methods

Retrospective review of patients in whom TNFI-induced psoriasis was diagnosed between 2003 and 2013.

Results

A total of 102 patients with TNFI-induced psoriasis were identified. The mean age of onset was 40 years, and there was a female predominance (73.5%). Crohn's disease (in 48% of cases) and rheumatoid arthritis (in 24.5% of cases) were the most common primary conditions. Infliximab (in 52% of cases) was the most common inciting agent. The most common TNFI-induced psoriasis subtypes were plaque-type psoriasis (49.5%), scalp psoriasis (47.5%), and palmoplantar pustulosis (41%). Topical medications alone improved or resolved TNFI-induced psoriasis in 63.5% of patients, and cyclosporine and methotrexate (>10 mg weekly) were often effective if topicals failed. Discontinuation of the inciting TNFI with or without other interventions improved or resolved TNFI-induced psoriasis in 67% of refractory cases, whereas switching TNFIs resulted in persistence or recurrence in 64%.

Limitations

Retrospective nature of the study and the fact that some patients may have developed typical psoriasis unresponsive to TNFIs.

Conclusion

Our study cohort represents the largest single-institution cohort of patients with TNFI-induced psoriasis diagnosed and managed or comanaged by dermatologists to date. On the basis of our findings, we propose a treatment algorithm for TNFI-induced psoriasis.

中文翻译：

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TNF-α抑制剂引起的牛皮癣：在克利夫兰诊所的十年经验

背景

尽管已在15年前进行了描述，但肿瘤坏死因子-α（TNF-α）抑制剂（TNFI）诱导的牛皮癣仍知之甚少。由于TNFI常常可以改变患者的生活，因此了解TNFI诱导的牛皮癣的有效治疗方法很重要。

客观的

我们对一群由TNFI引起的牛皮癣患者进行了研究，该患者的牛皮癣是由一家单一的三级医疗机构的皮肤科医生专门诊断，管理或共同管理的，历时10年。

方法

回顾性分析2003年至2013年间诊断为TNFI诱导的牛皮癣的患者。

结果

总共确定了102例TNFI诱导的牛皮癣患者。平均发病年龄为40岁，女性占多数（73.5％）。克罗恩病（占48％的病例）和类风湿关节炎（占24.5％的病例）是最常见的主要疾病。英夫利昔单抗（占52％）是最常见的诱因。TNFI诱导的最常见的银屑病亚型是牙菌斑型银屑病（49.5％），头皮牛皮癣（47.5％）和掌ust脓疱病（41％）。仅局部用药可改善或解决TNFI引起的牛皮癣，占63.5％的患者，如果局部用药失败，环孢素和甲氨蝶呤（每周> 10 mg）通常有效。在67％的难治性病例中，无论是否采用其他干预措施，停止刺激性TNFI均可改善或解决TNFI诱导的牛皮癣，

局限性

研究的回顾性性质和某些患者可能已发展为对TNFI无反应的典型银屑病的事实。

结论

我们的研究队列代表了迄今为止由皮肤科医生诊断和管理或共同管理的由TNFI诱导的牛皮癣患者的最大单一机构队列。根据我们的发现，我们提出了一种由TNFI诱导的牛皮癣的治疗算法。