• PDF / 139,575 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 30 Downloads / 144 Views

DOWNLOAD

REPORT

---

1

S

Psoriasis and psoriasiform lesions: 7 case reports A retrospective chart review study identified 7 patients who developed psoriasis or psoriasiform lesions during therapy with adalimumab, etanercept or infliximab [routes not stated]. A 57-year-old woman with rheumatoid arthritis (RA) started etanercept 50 mg/week. After 4 months, mild, small elevated and pustulous and non-pruriginous lesions occurred on the soles of both feet. Etanercept was withheld after several months and the lesions improved. A 66-year-old man with peripheral spondylarthritis was initiated on etanercept 50 mg/week, which was stopped after 4 months due to clinical remission of his disease. Two weeks later, he developed a generalised psoriasiform pustular rash that required hospitalisation. He received topical treatment including clobetasol, and oral cephalosporins. He was discharged from hospital with topical treatment but was lost to follow-up. A 44-year-old woman with psoriatic arthritis started etanercept 50 mg/week. After 38 months, small, pustular, desquamative lesions developed on the soles of her feet. The etanercept frequency was reduced to every 15 days. Seven months later the skin lesions persisted and etanercept was spaced every 21–30 days, with resolution of the lesions. A 32-year-old woman with RA was started on adalimumab 40 mg/15 days. After 10 months, palmoplantar pustular lesions developed, and adalimumab was spaced monthly thereafter. Topical treatment was introduced. Adalimumab every 15 days was reinstated due to reactivation of RA, but the drug was withdrawn due to persistence of the skin lesions. The lesions resolved, and she was commenced on etanercept with no recurrence of the lesions. A 31-year-old man with ankylosing spondylitis commenced adalimumab 40 mg/15 days. After 2 months small, elevated pustular lesions emerged on the palms and soles. Adalimumab was spaced at once per month, and he was treated with topical potassium permanganate and PUVA of the feet and hands. The skin lesions resolved. A 65-year-old woman with acquired hyperostosis syndrome involving palmoplantar pustulosis was initiated on infliximab 400 mg/8 weeks. After 3 months, moderate pustulosis relapsed on her palms and soles. Infliximab was stopped as she had no joint symptoms. The skin lesions subsequently improved. A 56-year-old woman with psoriatic arthritis was started on adalimumab 40 mg/15 days. After 1 month, small erythematous squamous plaques developed on both elbows, compatible with classic psoriasis. Adalimumab was continued and the skin lesions persisted. Author comment: "Despite the efficacy of anti-TNFα drugs in application to psoriasis, as demonstrated by different clinical trials, in recent years, there have been a growing number of reports of exacerbation, worsening, or the appearance of new psoriasiform conditions". Lopez-Robles A, et al. Psoriasis and psoriasiform lesions induced by TNF-alpha antagonists: The experience of a tertiary care hospital from northern Spain. Rheumatology International 32: 3779-3783, No. 12, Dec 2012. A