Acta Dermato-Venereologica 99-13CompleteContent | Page 25

SHORT COMMUNICATION 1293 Possible Paradoxical Photosensitive Psoriasis Induced by Tumour Necrosis Factor-alpha Inhibitors Pauline BATAILLE 1,2 , Adèle DE MASSON 1,2 , Marie-Dominique VIGNON-PENNAMEN 3 , Jean-David BOUAZIZ 1,2 * and Jean- Marc GORNET 2,4 1 Dermatology Department, 3 Pathology Department and 4 Gastroenterology Department, Hôpital Saint Louis, AP-HP, 1 Avenue Claude Vellefaux, FR-75010 Paris, and 2 Paris VII Sorbonne Paris Cité University, Paris, France. *E-mail: [email protected] Accepted Oct 3, 2019; E-published Oct 3, 2019 Paradoxical psoriasis (PP) is the most frequent derma- tological side-effect of tumour necrosis factor (TNF) inhibitors. Photosensitive psoriasis has rarely been re- ported to date, and mostly in the paediatric population. We report here an unusual case of sun-induced PP in an adult patient treated with infliximab for Crohn’s disease. CASE REPORT A 23-year-old man, non-smoking, with no significant per- sonal or familial past medical history presented an acute eruption on the face in June 2017. He had been followed up since November 2012 for stricturing Crohn’s disease, reaching the last 30 cm of the ileum and revealed by chronic right iliac fossa pain and constipation. Infliximab (IFX) was started in April 2015 for chronic active disease despite long-lasting steroids use and maintenance therapy with azathioprine. Magnetic resonance enterography af- ter one year of IFX revealed a regression of small bowel thickening and disappearance of parietal enhancement on delayed phase. While the patient was in complete clinical remission, he developed the eruption (Fig. 1). The last in- fusion of IFX had been administered 3 weeks previously. Dermatological examination revealed an itchy and very well limited erythematous papulosquamous eruption of the face and neck. There was no fever and the rest of the physical examination was unremarkable. The only possible triggering factor was a photo exposition. The patient had not applied plants or topical treatments to the skin. He had not taken any photosensitizing drugs or concomitant therapy for Crohn’s disease. Blood tests, including complete blood cells, C-reactive protein, serum electrolytes, creatinine concentration, and liver tests, were normal. On skin biopsy, the epidermis was acanthotic with elongation of the rete ridges and parakeratotic. It was also spongiotic with migration of lymphocytes. The dermal infiltrate was composed of lymphocytes and few neutrophils. These features were suggestive of PP (Fig. 2). Due to the eruption severity, IFX was discontinued and topical tacrolimus was in- troduced. Skins lesions dramatically improved after 2 weeks and completely healed after 8 weeks. There was no recurrence of psoriasis lesions after a follow-up of 2 years. DISCUSSION PP following anti-TNF-α therapy occurred most fre- quently among women and patients with a personal or familial history of psoriasis, with a predilection for palmoplantar pustulosis and increased incidence of psoriatic arthritis (1–4). In a French single-centre ob- servational cohort of 583 patients, the prevalence rate of PP was 10.1% after a mean duration of 38.5 months of treatment. Anti-TNF-α was discontinued in 18.6% of cases (2). In this study, young age and duration of the involved anti-TNF-α agent were significantly associated with onset of PP. After switching to another anti-TNF-α Fig. 1. Clinical features. Erythematous papulosquamous eruption of the face and neck. Permission given to publish these photos. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3330 Acta Derm Venereol 2019; 99: 1293–1294