CME Topic

Adverse Cutaneous Reactions Induced by TNF-&agr; Antagonist Therapy

Authors: Joaquín Borrás-Blasco PharmD, PhD, Andrés Navarro-Ruiz PharmD, PhD, Consuelo Borrás PharmD, PhD, Elvira Casterá PharmD

Abstract

Objective:To review adverse cutaneous drug reactions induced by tumor necrosis factor alpha (TNF-&agr;) antagonist therapy.Methods:A literature search was performed using PubMed (1996–March 2009), EMBASE, and selected MEDLINE Ovid bibliography searches. All language clinical trial data, case reports, letters, and review articles identified from the data sources were used.Results:Since the introduction of TNF-&agr; antagonist, the incidence of adverse cutaneous drug reactions has increased significantly. A wide range of different skin lesions might occur during TNF-&agr; antagonist treatment. New onset or exacerbation of psoriasis has been reported in patients treated with TNF-&agr; antagonists for a variety of rheumatologic conditions. TNF-&agr; antagonist therapy has been associated with a lupus-like syndrome; most of these case reports occurred in patients receiving either etanercept or infliximab. Serious skin reactions such as erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis have been reported rarely with the use of TNF-&agr; antagonists.Conclusions:As the use of TNF-&agr; antagonists continues to increase, the diagnosis and management of cutaneous side effects will become an increasingly important challenge. In patients receiving TNF-&agr; antagonist treatment, skin disease should be considered, and clinicians need to be aware of the adverse reactions of these drugs.

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