Dermatological Manifestations in Pediatric Patients with Inflammatory Bowel Diseases on Anti-TNF Therapy.

BACKGROUND: Anti-tumor necrosis factor (anti-TNF) therapies are effective treatments for inflammatory bowel diseases (IBD). However, infections, psoriasis, and eczema are potential manifestations. Descriptions of these are limited. Our aim was to characterize these skin manifestations in children with IBD on anti-TNF therapy.

METHODS: Our study is a retrospective review of IBD patients ranging in age from 6 to 18 years who were treated with anti-TNFs from 2010-2015. Data collected included demographics, clinical information, anti-TNF therapy used, and whether patients developed skin manifestations and their type of complication, clinical interventions, and outcomes.

RESULTS: Of the 409 patients analyzed, 47 (11.4%) developed dermatologic manifestations (39 CD, 8 UC/IC). Among these 47 patients, there were 72 manifestations of infections (28/72; 38.9%), psoriasis (33/72; 45.8%), and eczema (10/72; 13.9%). There was no significant difference between patients with CD and UC/IC in the type of manifestation. Children on infliximab experienced an increased risk of psoriasis than those on adalimumab (P = 0.05). A greater percentage of female patients developed a skin manifestation (28/47; 60%). The majority of patients with a skin manifestation were able to continue the current anti-TNF regimen. Amongst the patients that developed psoriasis, 60% did not require change in anti-TNF therapy.

CONCLUSIONS: This is the largest study analyzing anti-TNF related skin manifestations in a pediatric IBD cohort. Psoriasiform lesions were the most prevalent dermatological manifestation, and females experienced more reactions than males. Most patients were able to continue their anti-TNF therapy. However, if a change was required, it was most likely among those who developed psoriasis and required either a dose or interval change, different anti-TNF medication, or a medication class change.