PMID- 37664349
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230905
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 8
DP  - 2023 Aug
TI  - Paradoxical Tumor Necrosis Factor-Alpha (TNF-alpha) Inhibitor-Induced Psoriasis: A 
      Systematic Review of Pathogenesis, Clinical Presentation, and Treatment.
PG  - e42791
LID - 10.7759/cureus.42791 [doi]
LID - e42791
AB  - Tumor necrosis factor-alpha (TNF-alpha) inhibitors have been shown to be well 
      tolerated among patients with rheumatoid arthritis, inflammatory bowel disease, 
      and psoriasis. Meanwhile, more recently, clinical practice and research efforts 
      have uncovered increasing cases of psoriatic lesion development tied to 
      initiating treatment with a TNF-alpha inhibitor. The underlying mechanisms associated 
      with this occurrence have yet to be fully elucidated. A review and analysis of 
      cases of paradoxical psoriasis currently published in the literature is 
      warranted. In addition, exploring possible mechanisms of action and potential 
      treatment options associated with favorable outcomes is much needed. A systematic 
      literature review was performed utilizing PubMed and Google Scholar databases 
      (1992-present), in which 106 cases of paradoxical psoriasis were reviewed. The 
      most common morphology developed was plaque psoriasis vulgaris. There was a 
      female predominance (61.3%), and the most common underlying autoimmune disease 
      was rheumatoid arthritis (45.3%). In addition, the most commonly associated drug 
      with the onset of psoriatic lesions was infliximab (62.3%). Furthermore, the 
      findings suggest that the most well-supported mechanism of action involves the 
      uncontrolled release of interferon-alpha (IFN-alpha) from plasmacytoid dendritic 
      cells (pDCs) after TNF-alpha inhibition. While TNF-alpha inhibitors have been shown to 
      have great benefits to patients with rheumatologic diseases, cases of paradoxical 
      psoriasis demonstrate the importance of close monitoring of patients on TNF-alpha 
      inhibitors to allow for early recognition, treatment, and potentially change to a 
      different mechanism of action of the medication used to prevent further 
      progression of the inflammatory lesions.
CI  - Copyright (c) 2023, Chokshi et al.
FAU - Chokshi, Aditi
AU  - Chokshi A
AD  - Dermatology, Nova Southeastern University Dr. Kiran C. Patel College of 
      Osteopathic Medicine, Davie, USA.
FAU - Demory Beckler, Michelle
AU  - Demory Beckler M
AD  - Microbiology and Immunology, Nova Southeastern University Dr. Kiran C. Patel 
      College of Allopathic Medicine, Davie, USA.
FAU - Laloo, Anita
AU  - Laloo A
AD  - Rheumatology, Nova Southeastern University Dr. Kiran C. Patel College of 
      Osteopathic Medicine, Davie, USA.
FAU - Kesselman, Marc M
AU  - Kesselman MM
AD  - Rheumatology, Nova Southeastern University Dr. Kiran C. Patel College of 
      Osteopathic Medicine, Davie, USA.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20230801
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC10469896
OTO - NOTNLM
OT  - paradoxical
OT  - pathogenesis
OT  - psoriasis
OT  - tnf-a inhibitor
OT  - treatment
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/09/04 06:42
MHDA- 2023/09/04 06:43
PMCR- 2023/08/01
CRDT- 2023/09/04 05:12
PHST- 2023/07/06 00:00 [received]
PHST- 2023/07/31 00:00 [accepted]
PHST- 2023/09/04 06:43 [medline]
PHST- 2023/09/04 06:42 [pubmed]
PHST- 2023/09/04 05:12 [entrez]
PHST- 2023/08/01 00:00 [pmc-release]
AID - 10.7759/cureus.42791 [doi]
PST - epublish
SO  - Cureus. 2023 Aug 1;15(8):e42791. doi: 10.7759/cureus.42791. eCollection 2023 Aug.