Psoriasiform Dermatitis During Infliximab Therapy for Ulcerative Colitis

Figure

Left lower leg with extensive erythematous plaques and marked, firmly adherent desquamation.

A 40-year-old male patient presented to our emergency department due to painful and pruritic skin lesions on both lower legs of 12 days‘ standing. With the exception of ulcerative colitis, which had been diagnosed 9 years previously and was being treated at the time of presentation with infliximab (5 mg/kg body weight), the patient had no other pre-existing diseases. The skin lesions had become apparent approximately 5 weeks following the second infusion with infliximab. Histological analysis showed signs of psoriasis as well as mixed-cell superficial perivascular dermatitis. Psoriasiform dermatitis was diagnosed on the basis of the clinical picture and in view of the frequency of cutaneous side effects in TNF-alpha blockade. The skin lesions rapidly resolved under intensified local anti-inflammatory treatment. Infliximab was interrupted for 4 weeks and continued every 8 weeks thereafter. No recurrence of the skin lesions was observed. Psoriasiform skin lesions frequently develop during anti-TNF-alpha therapy. Although the pathomechanism has not been definitively established, Th1 and Th17 cytokines appear to play a key role. Discontinuation of TNF-alpha blockade is only rarely necessary.

Dr. med. Peter Seiringer, Prof. Dr. med. Tilo Biedermann, Prof. Dr. med. Knut Brockow
Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum rechts der Isar der Technischen Universität München, [e-mail]

Conflict of interest statement:
Prof. Biedermann has served as a paid consultant for Novartis and Lilly.
Dr. Seiringer and Prof. Brockow state that there are no conflicts of interest.

Translated from the original German by Christine Rye.

Cite this as: Seiringer P, Biedermann T, Brockow K: Psoriasiform dermatitis during infliximab therapy for ulcerative colitis. Dtsch Arztebl Int 2020; 117: 652. DOI: 10.3238/arztebl.2020.0652