Cutaneous side effects of anti-tumor necrosis factor biologic therapy: A clinical review

Background: Anti-tumor necrosis factor (anti-TNF) biologic agents have been associated with a number of adverse events. Objective. To review the cutaneous reactions that have been reported in patients receiving anti-TNF therapy. Methods: We performed a systematic MEDLINE search of relevant publications, including case reports and case series. Results: Reported cutaneous events included infusion and injection site reactions, psoriasiform eruptions, lupus-like disorders, vasculitis, granulomatous reactions, cutaneous infections, and cutaneous neoplasms. Infusion reactions and injection site reactions were definitely associated with anti-TNF administration, whereas all other events had a varying strength of association and severity, not necessarily requiring drug discontinuation. Limitations: Most information was derived from spontaneous case reports, where ascertainment biases and frequency of reporting may impair detection methodology and causal relationships. Conclusions: As anti-TNF biologic agents are progressively being used in clinical practice, cutaneous adverse events will be encountered more frequently. Until more data are accumulated with respect to their pathogenesis and potential association with anti-TNF therapy, dermatologists should become more familiar with the clinical presentation and management Of Such events. (J Am Acad Dermatol 2009;61:486-504.)