Annals of the Rheumatic Diseases 2008;67:1181-1183
CONCISE REPORTS
Psoriasiform lesions induced by tumour necrosis factor antagonists: a skin-deep medical conundrum
1 Department of Internal Medicine, Division of Rheumatology, University of South Florida School of Medicine, Tampa, Florida, USA
2 Department of Immunology and Microbiology, Wayne State University School of Medicine, Detroit, Michigan, USA
3 Research Service, DVA Medical Center, Detroit, Michigan, USA
Dr J D Carter, Department of Internal Medicine, Division of Rheumatology, University of South Florida School of Medicine, 12901 Bruce B Downs Blvd MDC81, Tampa, Florida 33612, USA; jocarter{at}health.usf.edu
Rarely, tumour necrosis factor (TNF)
antagonist therapy has been associated with de novo psoriasiform eruptions. This is unusual in that these same drugs are used to treat psoriasis. Most of these cases involve the palms and soles, yet palmoplantar pustular psoriasis represents only 1.7% of all cases of psoriasis. Keratoderma blenorrhagicum is a psoriasiform rash that occurs primarily on the palms and soles of some patients with reactive arthritis. It is grossly and histologically indistinguishable from pustular psoriasis. Chlamydia trachomatis is a common aetiological agent for reactive arthritis, and in vitro studies have shown that chlamydial replication is inversely proportional to TNF levels. Three patients taking TNF antagonists are presented who developed such lesions and who were found to be positive for C trachomatis DNA in the affected skin. It is proposed that these psoriasiform lesions may not be psoriasis, but rather keratoderma blenorrhagicum.
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