Paradoxical cutaneous manifestations induced by TNF inhibitors in patients with inflammatory bowel disease

Background: Anti-TNF drugs have revolutionized the management of numerous inflammatory diseases, yet they may produce paradoxical effects. Materials and Methods: A descriptive study was conducted on patients with chronic inflammatory bowel disease (IBD) on anti-TNF therapy who had developed paradoxical psoriasis. Results: Out of a total of 218 patients followed for IBD on TNF inhibitors, five presented with paradoxical psoriasis. In four patients, a specific treatment for psoriasis was associated with anti-TNF treatment. In one patient, a swap to ustekinumab was decided. Good progress was noted in four patients. In one, there was no improvement of the psoriasis on methotrexate, which was switched to another anti-TNF agent. Conclusion: In our experience, TNF inhibitor-induced psoriasis is relatively rare (prevalence of 2.3%). The choice of treatment is reached by assessing the benefit-risk balance. Key words: Paradoxical cutaneous manifestations; TNF inhibitors; Cutaneous manifestations; Inflammatory bowel disease