Cutaneous manifestations during treatment with TNF-alpha blockers: 11 cases

Background. TNF alpha blockers have recently extended the therapeutic arsenal available in dermatology. However, dermatologists must be informed of their potential adverse dermatological effects. While the chief adverse effect of TNF alpha blockers is risk of infection, cutaneous adverse effects have not yet been clearly elucidated and publications on this topic are few and far between. The aim of our study is to report various dermatological problems noted during treatment with TNF alpha blockers. Patients and methods. This was a retrospective study of patient files. The study population comprised patients receiving TNF alpha blockers and presenting cutaneous reaction, and seen in the dermatology department between August 2001 and December 2004. Results. Eleven patients were included. The following cutaneous reactions were seen: delayed skin rash (1 case), lupus syndrome (1 case), cutaneous vasculitis (2 cases), palmoplantar pustulosis (2 cases), psoriasis vulgaris (1 case), atopic dermatitis (1 case), lichenoid rash (1 case), purpuric capillaritis (1 case) and melanoma (1 case). Discussion. The cutaneous manifestations seen represented a wide range of different clinical pictures. Dermatologists must be aware of these potential adverse effects. Future improvement of knowledge of the physiolpathological mechanisms as well as the institution of prospective cohort studies should provide clearer guidance on the management of such symptoms.