Crohn's Disease Forum » Parents of Kids with IBD » Tnf alpha induced psorasis

04-26-2014, 09:04 PM   #1
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Tnf alpha induced psorasis

Results: Among 434 anti-TNF-treated patients with IBD, 21 (4.8%) developed psoriasiform skin lesions. Multiple logistic regression revealed smoking (p=0.007; OR 4.24, 95% CI 1.55 to 13.60) and an increased body mass index (p=0.029; OR 1.12, 95% CI 1.01 to 1.24) as main predictors for these lesions. Nine patients with Crohn's disease and with severe psoriasiform lesions and/or anti-TNF antibody-induced alopecia were successfully treated with the anti-p40-IL-12/IL-23 antibody ustekinumab (response rate 100%). Skin lesions were histologically characterised by infiltrates of IL-17A/IL-22-secreting T helper 17 (Th17) cells and interferon (IFN)-γ-secreting Th1 cells and IFN-α-expressing cells. IL-17A expression was significantly stronger in patients requiring ustekinumab than in patients responding to topical therapy (p=0.001). IL23R genotyping suggests disease-modifying effects of rs11209026 (p.Arg381Gln) and rs7530511 (p.Leu310Pro) in patients requiring ustekinumab.

Conclusions: New onset psoriasiform skin lesions develop in nearly 5% of anti-TNF-treated patients with IBD. We identified smoking as a main risk factor for developing these lesions. Anti-TNF-induced psoriasiform skin lesions are characterised by Th17 and Th1 cell infiltrates. The number of IL-17A-expressing T cells correlates with the severity of skin lesions. Anti-IL-12/IL-23 antibody therapy is a highly effective therapy for these lesions.

Anti-TNF Antibody-Induced Psoriasiform Skin Lesions in Patients With Inflammatory Bowel Disease Are Characterised by Interferon-γ-Expressing Th1 Cells and IL-17A/IL-22-Expressing Th17 Cells and Respond to Anti-IL-12/IL-23 Antibody Treatment
Cornelia Tillack, Laura Maximiliane Ehmann, Matthias Friedrich, Rüdiger P Laubender, Pavol Papay, Harald Vogelsang, Johannes Stallhofer, Florian Beigel, Andrea Bedynek, Martin Wetzke, Harald Maier, Maria Koburger, Johanna Wagner, Jürgen Glas, Julia Diegelmann, Sarah Koglin, Yvonne Dombrowski, Jürgen Schauber, Andreas Wollenberg, Stephan BrandDisclosures
Gut. 2014;63(4):567-577.

DS - -Crohn's -Stelara -mtx
04-26-2014, 10:43 PM   #2
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Join Date: Apr 2013
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That is very interesting. Eczema and Psoriasis are clearly different but when I went on Humira my Exzema mostly went away but when I went off it, it came back soooooo bad, like it was playing catch up for all the times it missed. hahaha
04-28-2014, 09:39 AM   #3
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Tagging crohnsinct - might be of interest to you...
Tess, mom to S
Diagnosed May 2011

May-July 2011 - 6 wks Exclusive EN via NG tube - 2000 ml/night, 1 wk IV Flagyl
July 2011-July 2013 - Supplemental EN via NG, 1000 ml/night, 5 nites/wk, Nexium, 40 mg
Feb. 2013-present - Remicade, 5 mg/kg every 6 wks
Supplements: 1-2 Boost shakes, D3 - 2000 IUs, Krill Oil
04-28-2014, 10:22 AM   #4
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Perfect timing MLP as O's psoriasis is attacking with a vengeance right now! A recent levels test showed her Remicade as high at the end of her cycle so we are pushing out infusions. Hopefully this will help her psoriasis but in the meanwhile I am showing her derm and GI this.

I am pretty sure she doesn't smoke and for sure she doesn't have gigh BMI but I do know those are risk factors of psoriasis in general anyway.
Daughter O dx 2/1/12 at age 12
Crohns & Remicade induced Psoriasis
Vit d 2000IU
Multi vitamin plus iron

Previously used - Prednisone, Prevacid, Enteral Nutrition, Methotrexate oral and injections, Folic Acid, Probiotics, Cortofoam

Daughter T dx 1/2/15 at age 11
Vitaligo, Precoscious puberty & Crohn's
Vit D 2000IU

Previously used, Exclusive Enteral Nutrition, Methotrexate (injections and oral), Folic Acid, Entocort,IBD-AID Diet
04-28-2014, 01:38 PM   #5
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I did not smoke, nor have high BMI (was under 20) still got psoriasiform lesion occur while I was on humira (completely resolved once I stopped taking it). There is still lots of things to learn regarding these therapies...

I'm eager for therapies that targets the problem only... For that would we need to know the exact cause of it.

Why oh why can't I get into a god darn lab like I wish lol (LONG LONG story but the woman out here could rant so much... )
Diagnosed UC 1999 then refractory CD.
Past Meds: Prednisone, asacol, cyclosporine, cyclophosphamide, mp6, Humira

Currently taking: Omega-3, D-3, med-free for the time being.
~~Oh! n sorry if what I write seems strange at times, English is not my main language!~~

You'd like to chat and feel facebook would ease this point,
send me a private message and i'll do so =)
04-28-2014, 02:35 PM   #6
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HA! I smoked back in 1999 when I started Remicade. I developed Psoriasis of the Extremities. I stopped smoking in 2008, still on remicade at the time.

I didn't notice how my psoriasis changed when I quit smoking (I was also pregnant and stopped Remicade shortly before giving birth).

Psoriasis did improve when I went on Humira in 2010 and has come back a bit when I stopped Humira (in February). I think it has evened out though because my skin lesion on my foot has not been too itchy lately and ive not treated it.

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