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Psoriasiform Eruptions During Anti–TNF-α Treatment: Psoriasis or Not?

Julien Seneschal, MD; Sébastien Lepreux, MD; Brigitte Milpied, MD; Thierry Schaeverbeke, MD, PhD; Alain Taïeb, MD, PhD
Arch Dermatol. 2007;143(12):1589-1603. doi:10.1001/archderm.143.12.1593.
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We read with interest the report by de Gannes et al1 concerning psoriasis triggered by tumor necrosis factor α (TNF-α) inhibitors. The paradoxical induction of psoriasislike eruption in patients treated with anti–TNF-α agents was first described by Verea et al2 in 2004. Since that time, more than 70 cases of psoriasiform eruptions have been reported in patients with autoinflammatory diseases who are undergoing treatment with anti–TNF-α agents. The major clinical presentation is palmoplantar pustulosis sometimes accompanied by guttate or plaquelike psoriasis. In 20 cases, histologic findings were consistent with psoriasis. In other reports, skin biopsy findings were not typical of psoriasis or showed a lichenoid2 pattern. However, psoriasiform eruptions were not always analyzed histologically.

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Psoriasiform eruption triggered by tumor necrosis factor α inhibitor. A, Delayed distant positive reading showing a lesion consistent with an erythematous and squamous plaque. B, Histological features include mixed lichenoid and spongiotic patterns.

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