Psoriasis and palmoplantar pustulosis associated with tumor necrosis factor-α inhibitors: The Mayo Clinic experience, 1998 to 2010

Background: Tumor necrosis factor (TNF)-alpha antagonists have been associated with the induction of de novo or worsening psoriasis. Objective: We sought to retrospectively examine the clinical characteristics and outcomes of patients with psoriasis associated with anti-TNF-alpha therapy. Methods: We performed a retrospective review of patients with new-onset or worsening psoriasis during TNF-alpha inhibitor therapy between 1998 and 2010. Results: Of the 56 patients (mean age at psoriasis onset, 48.1 years), 41 (73%) were female. In all, 22 patients (39%) had Crohn's disease and 14 (25%) had rheumatoid arthritis. Thirty patients (54%) were treated with infliximab, 19 (34%) with adalimumab, and 7 (12%) with etanercept. New-onset or worsening psoriasis occurred after a mean treatment duration of 17.1 months. Plaque psoriasis (n = 27), palmoplantar pustulosis (n = 25), scalp psoriasis (n = 12), generalized pustular psoriasis (n = 7), erythrodermic psoriasis (n = 2), and inverse psoriasis (n = 2) were the cutaneous presentations. Among the 39 patients for whom full treatment response data were available, 33 (85%) had a complete or partial response; combined response rates (complete and partial) were slightly higher among those who discontinued anti-TNF-alpha therapy (16 of 17 patients [94%]) than among those who continued anti-TNF-alpha therapy (17 of 22 patients [77%]). Limitations: Retrospective nature, possible referral bias, and lack of complete follow-up for some patients are limitations. Conclusion: Although some patients sufficiently controlled their psoriasis while continuing anti-TNF-alpha therapy, those who discontinued therapy achieved higher rates of complete response. Further studies should explore the efficacy and safety of switching to an alternative anti-TNF-alpha agent. (J Am Acad Dermatol 2012;67:e179-85.)