PMID- 18491481
OWN - NLM
STAT- MEDLINE
DCOM- 20080904
LR  - 20151119
IS  - 0011-4162 (Print)
IS  - 0011-4162 (Linking)
VI  - 81
IP  - 4
DP  - 2008 Apr
TI  - Interstitial granulomatous dermatitis in a patient with rheumatoid arthritis on 
      etanercept.
PG  - 336-8
AB  - Tumor necrosis factor-alpha (TNF-alpha) has been implicated in the pathogenesis 
      of numerous inflammatory conditions, possibly facilitating the induction and 
      maintenance of these diseases through lymphocyte activation and cytokine 
      production. Inhibitors of TNF-alpha have proven efficacious in the treatment of 
      autoimmune diseases such as psoriasis, rheumatoid arthritis, inflammatory bowel 
      disease, and lymphoproliferative disorders. However, recent cases of adverse 
      cutaneous reactions have been reported in anti-TNF-alpha therapy, most notably 
      those of granulomatous morphology. We report a patient with rheumatoid arthritis 
      who had been treated with etanercept (50 mg/wk) for 6.5 years. The patient 
      subsequently developed pink and red papules on large areas of the upper and lower 
      extremities. Skin biopsy specimens revealed both poorly formed and 
      well-circumscribed nonnecrotizing epithelioid granulomas in the superficial 
      dermis. Application of clobetasol propionate ointment 0.05% without 
      discontinuation of anti-TNF-alpha therapy led to complete resolution of the skin 
      lesions. While the precise mechanisms of physiologic and pathologic TNF activity 
      remain to be determined, it is clear that granulomatous lesions may emerge as a 
      complication of anti-TNF-alpha therapy. Treatment with topical corticosteroids 
      may be sufficient to eliminate such lesions.
FAU - Hu, Stephanie
AU  - Hu S
AD  - Department of Dermatology, Harvard Medical School, Boston, Massachusetts 02115, 
      USA.
FAU - Cohen, Darel
AU  - Cohen D
FAU - Murphy, George
AU  - Murphy G
FAU - Mody, Elinor
AU  - Mody E
FAU - Qureshi, Abrar A
AU  - Qureshi AA
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Cutis
JT  - Cutis
JID - 0006440
RN  - 0 (Anti-Inflammatory Agents)
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Immunoglobulin G)
RN  - 0 (Receptors, Tumor Necrosis Factor)
RN  - ADN79D536H (Clobetasol)
RN  - OP401G7OJC (Etanercept)
SB  - IM
CIN - Cutis. 2009 Jan;83(1):50. PMID: 19271571
MH  - Anti-Inflammatory Agents/therapeutic use
MH  - Antirheumatic Agents/*adverse effects
MH  - Arthritis, Rheumatoid/*drug therapy
MH  - Clobetasol/therapeutic use
MH  - Drug Eruptions/drug therapy/*etiology
MH  - Etanercept
MH  - Female
MH  - Granuloma/*chemically induced/drug therapy
MH  - Humans
MH  - Immunoglobulin G/*adverse effects
MH  - Middle Aged
MH  - Receptors, Tumor Necrosis Factor
EDAT- 2008/05/22 09:00
MHDA- 2008/09/05 09:00
CRDT- 2008/05/22 09:00
PHST- 2008/05/22 09:00 [pubmed]
PHST- 2008/09/05 09:00 [medline]
PHST- 2008/05/22 09:00 [entrez]
PST - ppublish
SO  - Cutis. 2008 Apr;81(4):336-8.