Paradoxical psoriasiform skin eruption in paediatric patients with inflammatory bowel disease treated with tumour necrosis factor-α inhibitors

Background Tumour necrosis factor α (TNF-α) inhibitor (TNFi)-induced psoriasiform eruptions are a well-known phenomenon among adults. However, data are limited regarding this reaction in children. Objectives To describe in paediatric patients with inflammatory bowel disease (IBD) the clinical characteristics of TNFi-induced psoriasiform eruptions and the outcomes of various therapeutic options. Methods We reviewed the medical charts of paediatric patients (aged<18 years) with IBD who developed TNFi-induced psoriasiform eruptions during 2006–2022. Results Among 454 patients with IBD treated with TNFis, 58 (12.8%) were diagnosed with TNFi-induced psoriasiform eruptions, of whom 51 were included in the study. The female to male ratio was 1: 1.3. The median age at skin eruption was 14.11 [interquartile range (IQR) 12.11–16.05] years. The median elapsed time to eruption appearance was 15.00 months (IQR 7.00–24.00) after initiation of the treatment. All 51 patients were treated with topical steroids and 17 (33%) needed systemic treatment (phototherapy, methotrexate or acitretin). Sixteen of 51 patients (31%) needed to stop TNFi treatment because of an intractable eruption. Female patients, patients with inflammatory alopecia and patients who were treated with methotrexate or phototherapy were more prone to stop TNFis. Conclusions TNFi-induced psoriasiform eruptions are common in paediatric patients with IBD. The eruption may appear months or even years after treatment initiation. Almost one-third of the described patients had to replace their treatment because of a recalcitrant cutaneous eruption. This indicates that a multidisciplinary approach is required.