Paradoxical psoriasiform inflammatory reaction during the use of tumor necrosis factor-alpha inhibitors in patients with Crohn’s disease (a review of the literature and presentation of two clinical cases)
Psoriasiform rash (paradoxical inflammation) induced by tumor necrosis factor-alpha (TNFα) inhibitors is observed in about 5–10% of patients with inflammatory bowel diseases treated by these genetically engineered agents. Its predictors include gender (mostly female), smoking, h...
| Main Authors: | , |
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| Format: | Article |
| Language: | Russian |
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MONIKI
2018-11-01
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| Series: | Alʹmanah Kliničeskoj Mediciny |
| Subjects: | |
| Online Access: | https://www.almclinmed.ru/jour/article/view/883 |
| _version_ | 1818623727169961984 |
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| author | L. S. Kruglova O. B. Shchukina |
| author_facet | L. S. Kruglova O. B. Shchukina |
| author_sort | L. S. Kruglova |
| collection | DOAJ |
| description | Psoriasiform rash (paradoxical inflammation) induced by tumor necrosis factor-alpha (TNFα) inhibitors is observed in about 5–10% of patients with inflammatory bowel diseases treated by these genetically engineered agents. Its predictors include gender (mostly female), smoking, higher body mass index, and formation of anti-neutrophil antibodies. There is no correlation between the paradoxical inflammation and specific agent; the rash can develop with the use of any TNFα inhibitor, such as infliximab, adalimumab, or certolizumab pegol. The first line of treatment for pharmacologically induced psoriasis includes topical corticosteroids (mostly, high potency agents clobetasol and betamethasone) and combination steroid-containing agents (betamethasone + calcipotriol). If this treatment is ineffective or the rash recurs during the use of TNFα inhibitors, the rash is qualified as a class-specific effect, with consideration of switching the patient to a genetically engineered product with another mechanism of action. In such a case, there is a strong indication for ustekinumab. Despite a relatively high incidence of the paradoxical inflammation with TNFα inhibitors and a bulk of published data, some questions remain unanswered. In particular, further studiesare required into the time intervals between the achievement of a clinically significant effect of TNFα inhibitors on the symptoms of inflammatory bowel diseases and the skin rash formation, which means the possibility of treatment withdrawal and change of the treatment strategy, as well as studies on the long-term prognosis of the skin lesions. In this context, clinical case presentation and the accumulated experience would subsequently help to formulate actual clinical recommendations on the management of this patient category. |
| first_indexed | 2024-12-16T18:45:39Z |
| format | Article |
| id | doaj.art-a423602830f141bb9854711935c12e19 |
| institution | Directory Open Access Journal |
| issn | 2072-0505 2587-9294 |
| language | Russian |
| last_indexed | 2024-12-16T18:45:39Z |
| publishDate | 2018-11-01 |
| publisher | MONIKI |
| record_format | Article |
| series | Alʹmanah Kliničeskoj Mediciny |
| spelling | doaj.art-a423602830f141bb9854711935c12e192022-12-21T22:20:51ZrusMONIKIAlʹmanah Kliničeskoj Mediciny2072-05052587-92942018-11-0146552253010.18786/2072-0505-2018-46-5-522-530561Paradoxical psoriasiform inflammatory reaction during the use of tumor necrosis factor-alpha inhibitors in patients with Crohn’s disease (a review of the literature and presentation of two clinical cases)L. S. Kruglova0O. B. Shchukina1Central State Medical Academy of Department of Presidential AffairsAcademician I.P. Pavlov First St. Petersburg State Medical UniversityPsoriasiform rash (paradoxical inflammation) induced by tumor necrosis factor-alpha (TNFα) inhibitors is observed in about 5–10% of patients with inflammatory bowel diseases treated by these genetically engineered agents. Its predictors include gender (mostly female), smoking, higher body mass index, and formation of anti-neutrophil antibodies. There is no correlation between the paradoxical inflammation and specific agent; the rash can develop with the use of any TNFα inhibitor, such as infliximab, adalimumab, or certolizumab pegol. The first line of treatment for pharmacologically induced psoriasis includes topical corticosteroids (mostly, high potency agents clobetasol and betamethasone) and combination steroid-containing agents (betamethasone + calcipotriol). If this treatment is ineffective or the rash recurs during the use of TNFα inhibitors, the rash is qualified as a class-specific effect, with consideration of switching the patient to a genetically engineered product with another mechanism of action. In such a case, there is a strong indication for ustekinumab. Despite a relatively high incidence of the paradoxical inflammation with TNFα inhibitors and a bulk of published data, some questions remain unanswered. In particular, further studiesare required into the time intervals between the achievement of a clinically significant effect of TNFα inhibitors on the symptoms of inflammatory bowel diseases and the skin rash formation, which means the possibility of treatment withdrawal and change of the treatment strategy, as well as studies on the long-term prognosis of the skin lesions. In this context, clinical case presentation and the accumulated experience would subsequently help to formulate actual clinical recommendations on the management of this patient category.https://www.almclinmed.ru/jour/article/view/883inflammatory bowel diseasepsoriasispharmacologically induced psoriasisparadoxical psoriasistumor necrosis factor-alpha inhibitorsustekinumab |
| spellingShingle | L. S. Kruglova O. B. Shchukina Paradoxical psoriasiform inflammatory reaction during the use of tumor necrosis factor-alpha inhibitors in patients with Crohn’s disease (a review of the literature and presentation of two clinical cases) Alʹmanah Kliničeskoj Mediciny inflammatory bowel disease psoriasis pharmacologically induced psoriasis paradoxical psoriasis tumor necrosis factor-alpha inhibitors ustekinumab |
| title | Paradoxical psoriasiform inflammatory reaction during the use of tumor necrosis factor-alpha inhibitors in patients with Crohn’s disease (a review of the literature and presentation of two clinical cases) |
| title_full | Paradoxical psoriasiform inflammatory reaction during the use of tumor necrosis factor-alpha inhibitors in patients with Crohn’s disease (a review of the literature and presentation of two clinical cases) |
| title_fullStr | Paradoxical psoriasiform inflammatory reaction during the use of tumor necrosis factor-alpha inhibitors in patients with Crohn’s disease (a review of the literature and presentation of two clinical cases) |
| title_full_unstemmed | Paradoxical psoriasiform inflammatory reaction during the use of tumor necrosis factor-alpha inhibitors in patients with Crohn’s disease (a review of the literature and presentation of two clinical cases) |
| title_short | Paradoxical psoriasiform inflammatory reaction during the use of tumor necrosis factor-alpha inhibitors in patients with Crohn’s disease (a review of the literature and presentation of two clinical cases) |
| title_sort | paradoxical psoriasiform inflammatory reaction during the use of tumor necrosis factor alpha inhibitors in patients with crohn s disease a review of the literature and presentation of two clinical cases |
| topic | inflammatory bowel disease psoriasis pharmacologically induced psoriasis paradoxical psoriasis tumor necrosis factor-alpha inhibitors ustekinumab |
| url | https://www.almclinmed.ru/jour/article/view/883 |
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