Dermatological side effects in rheumatological patients taking anti TNF-α treatment

Year 2016, Volume: 5 Issue: 1, 1 - 7, 01.01.2016

Serpil Tuna Sevil Alan Ülkü Uçar Mehmet İhsan Arman

https://doi.org/10.5505/abantmedj.2016.79058

Abstract

INTRODUCTION: In this study, we aimed to investigate dermatological side effects DSE seen in patients with rheumatic diseases taking TNF-α blocker. METHODS: A total number of 103 patients with chronic inflammatory rheumatic diseases on TNF-α blocker treatment were included into the study. All cutaneous leisons in patients were recorded as before and after TNF-α blocker treatment. TNF-α blockers-related DSE were grouped as infectious and non-infectious. The demographic and clinical characteristics of patients with DSE examined. In addition, demographic and clinical characteristics of the patients with infectious and non-infectious DSE were compared.RESULTS: 103 patients 40 female between the age of 18-74 were included into the study. Totally 63 cutaneous leisons occured during TNF-α blocker treatment were determined in 50 % 48.54 patients. 25 onychomycosis, 7 psoriasis, 1 diskoid lupus eritematozus, 1 basal cell carcinoma, 1 palmoplantar pustulosis, 28 other cutaneous lesions. 36 72% of patients with DSE had infectious skin lesions. 14 38% of patients with DSE had non-infectious skin. DSE were significantly higher in patients receiving concomitant methotrexate MTX . İnfectious DSE were significantly higher than non infectious DSE in patients receiving concomitant MTX. There was no relationship between DSE with the type of TNF-α blocker and rheumatic diseases.DISCUSSION AND CONCLUSION: As a result, DSE ranging from onychomycosis to malignancies can be seen during be seen during TNF-α blocker therapy. Monitoring for DSE of the patients receiving TNF-α blocker treatment is important for early diagnosis and treatment.

Keywords

TNF-α, blokers, rheumatic diseases, dermatological side effects

Anti TNF-α tedavisi alan romatoloji hastalarında dermatolojik yan etkiler

Abstract

GİRİŞ ve AMAÇ: Biz bu çalışmada, romatizmal hastalığı nedeniyle TNF-α bloker tedavisi alan hastalarda, tedavi süresince gelişmiş olan dermatolojik yan etkileri DYE saptamayı amaçladık.YÖNTEM ve GEREÇLER: Romatizmal hastalığı nedeniyle TNF-α bloker tedavisi alan 103 hasta çalışmaya dahil edildi. Hastalarda saptanan tüm cilt lezyonları, tedavi öncesi ve sonrası olarak kaydedildi. TNF-α bloker tedavisi sürecinde gelişen dermatolojik lezyonlar enfeksiyöz ve non-enfeksiyöz olarak gruplandırıldı. Tedavi sürecinde DYE geliştiren hastaların demografik ve kinik özellikleri incelendi. Ayrıca enfeksiyöz ve non-enfeksiyöz DYE gelişen hastaların demografik ve kinik özellikleri karşılaştırıldı.BULGULAR: Bu çalışma da yaşları 18-74 arasında değişen 103 hasta 40 kadın değerlendirildi. Toplam 50 % 48,54 hastada TNF-α bloker tedavi sürecinde gelişmiş 63 cilt lezyonu tespit edildi 25 onikomikoz, 7 psoriazis, 1 diskoid lupus eritematozus, 1 basal hücreli karcinom, 1 palmoplantar pustuloz, 28 diğer cilt lezyonu . Anti TNFα tedavi sürecinde DYE gelişmiş 50 hastanın 36 %72 ‘ sında enfeksiyöz, 14 %38 ’ ünde non-enfeksiyöz cilt lezyonları mevcuttu. Eş zamanlı methotrexate MTX kullanan hastalarda DYE anlamlı olarak daha sık bulundu. Bunlar arsında enfeksiyöz DYE’ lerin, non-enfeksiyöz olanlardan anlamlı olarak daha yüksek olduğu görüldü. Hastalığın tanısı ve kullanılan TNF-α bloker ile DYE ‘ ler arasında anlamlı bir fark bulunmadı.TARTIŞMA ve SONUÇ: TNF-α blokerler ile tedavi sürecinde, onikomikoz dan malignitelere kadar değişen yelpazede farklı dermatolojik yan etkiler gelişebilir. Sonuç olarak, TNF-α bloker tedavisi alan hastaların, DYE’ ler açısından takip edilmesi, erken tanı ve tedavi açısından önemlidir.

Keywords

TNF-α, blokerler, romatizmal hastlıklar, dermatolojik yan etkiler

References

• 1. Sehgal VN, Pandhi D, Khurana A. Biologics in dermatology: an integrated review. Indian J Dermatol 2014;59:425-41.
• 2. Machado NP, Neto ETD, Soares MR,Freitas DS, Porro A, Ciconelli RM, Pinheiro MM. The skin tissue is adversely affected by TNF-alpha blockers in patients with chronic inflammatory arthritis: a 5- year prospective analysis. Clinics 2013;68:1189-96.
• 3. Hernandez MV, Meineri M, Sanmarti R. Skin lesions and treatment with tumor necrosis factor alpha antagonists. Reumatol Clin 2013;9:53-61.
• 4. Farkas K, Nagy F, Kovacs L, Wittmann T, Molnar T. Anti-tumor necrosis factor-alpha induced systemic lupus erythematosus in a patient with metastatic Crohn's disease--what is the role of anti-TNF antibody? J Crohns Colitis 2013;7:143-5.
• 5. Hommes DW, Oldenburg B, van Bodegraven AA,van Hogezand RA, de Jong DJ, Romberg-Camps MJ, van der Woude J, Dijkstra G.Dutch Initiative on Crohn and Colitis (ICC).Guidelines for treatment with infliximab for Crohn's disease. Neth J Med 2006;64:219-29.
• 6. Subramanian S, Yajnik V, Sands BE, Cullen G, Korzenik JR. Characterization of patients with infliximab-induced lupus erythematosus and outcomes after retreatment with a second anti-TNF agent. Inflamm Bowel Dis 2011;17:99-104.
• 7. Sfikakis PP, Iliopoulos A, Elezoglou A, Kittas C, Stratigos A. Psoriasis induced by anti-tumor necrosis factor therapy: a paradoxical adverse reaction. Arthritis and rheumatism 2005;52:2513-8.
• 8. Osorio F, Magro F, Lisboa C, Lopes S, Macedo G, Bettencourt H, Azevedo F, Magina S.Anti-TNF-alpha induced psoriasiform eruptions with severe scalp involvement and alopecia: report of five cases and review of the literature. Dermatology 2012;225:163-7.
• 9. Richetta A, Mattozzi C, Carlomagno V,Maiani E, Carboni V, Giancristoforo S, D'Epiro S, Bruni F, Calvieri S.A case of infliximab-induced psoriasis. Dermatol Online j 2008;14:9.
• 10. Wendling D, Balblanc JC, Briancon D,Brousse A, Lohse A, Deprez P, Humbert P, Aubin F. Onset or exacerbation of cutaneous psoriasis during TNF alpha antagonist therapy. Joint Bone Spine 2008;75:315-8.
• 11. Glenn CJ, Kobraei KB, Russo JJ. New-onset psoriasis associated with adalimumab: a report of two cases. Dermatol Online J 2011;17:15.
• 12. Collamer AN, Guerrero KT, Henning JS, Battafarano DF. Psoriatic skin lesions induced by tumor necrosis factor antagonist therapy: a literature review and potential mechanisms of action. Arthritis and rheumatism 2008;59:996- 1001.
• 13. Fiorino G, Danese S, Pariente B, Allez M. Paradoxical immune-mediated inflammation in inflammatory bowel disease patients receiving anti-TNF-alpha agents. Autoimmun Rev 2014;13:15-9.
• 14. Collamer AN, Battafarano DF. Psoriatic skin lesions induced by tumor necrosis factor antagonist therapy: clinical features and possible immunopathogenesis. Seminars in arthritis and rheumatism 2010;40:233-40.
• 15. de Gannes GC, Ghoreishi M, Pope J, Russell A, Bell D, Adams S, Shojania K, Martinka M, Dutz JP.Psoriasis and pustular dermatitis triggered by TNF-alpha inhibitors in patients with rheumatologic conditions. Arch Dermatol 2007;143:223- 31.
• 16. Mercer LK, Green AC, Galloway JB, Davies R, Lunt M, Dixon WG, Watson KD; British Society for Rheumatology Biologics Register Control Centre Consortium,Symmons DP, Hyrich KL; British Society for Rheumatology Biologics Register.The influence of anti-TNF therapy upon incidence of keratinocyte skin cancer in patients with rheumatoid arthritis: longitudinal results from the British Society for Rheumatology Biologics Register. Annals of the Rheumatic Diseases 2012;71:869-74.
• 17. Askling J, Fahrbach K, Nordstrom B, Ross S, Schmid CH, Symmons D. Cancer risk with tumor necrosis factor alpha (TNF) inhibitors: meta-analysis of randomized controlled trials of adalimumab, etanercept, and infliximab using patient level data. Pharmacoepidemiol Drug Saf 2011;20:119-30.