Anti-tumor necrosis factor (anti-TNF) therapies are effectively used in the treatment of inflammatory bowel diseases (IBD). However, skin reactions including infections, psoriasis, and eczema are potential complications. Descriptions of anti-TNF associated dermatologic reactions in IBD patients are limited, with the first major study in adults published in 2014. Pediatric data is even more limited. Therefore our aim was to characterize the frequency and types of anti-TNF associated skin reactions in children with IBD treated with anti-TNF therapy.Methods:
We conducted a retrospective chart review of IBD patients between ages 6 to 18 years seen at our GI clinics who were treated with an anti-TNF therapy between 2010 to 2015. Data collected included patient demographics, clinical information including IBD phenotype, and type(s) of anti-TNF therapy used. We further examined the subset of patients that developed dermatologic complications and recorded information including the type of dermatologic complications, anti-TNF therapy duration, clinical interventions, and outcomes.Results:
Of the 409 patients whose charts we analyzed, 47 (11.4%) developed dermatologic complications (39 CD, 8 UC/IC). Among these 47 patients, reactions included infections (23/47 [49%]), psoriasiform lesions (31/47 [66%]), eczematiform lesions (10/47 [21%]), and erythema multiforme (1/47 [0.02%]). There was no significant difference between CD and UC/IC in the frequency of reaction types, age of complication, or rate of reaction when on infliximab or adalimumab. Age of complication was found to significantly differ between IBD types. 28/47 (60%) of patients with skin lesions were female. 60.9% (n = 14/23) of patients with infections, 67.9% (n = 19/31) of those with psoriasis, and 30.0% (n = 3/10) of those with eczema were female. Children on infliximab (n = 35) had a significantly greater frequency of psoriasis than patients treated with adalimumab (n = 12) (P = 0.04). No other analyzed variables differed significantly between the 2 anti-TNFs. 40.4% (n = 19/47) of patients achieved resolution of the lesion with specific treatment, which was usually topical (n = 15/47, 31.9%), or topical and oral (n = 6/47, 12.7%). Most patients with infections were able to have resolution of the skin lesion (n = 15/23, 65.2%). However, more patients with psoriasis (n = 12/31, 38.7%) and eczema (n = 6/10, 60.0%) only achieved partial improvement as opposed to resolution. Patients with psoriasis were treated with topical agents (n = 20/31, 64.2%) or both topical and oral therapy (n = 6/31, 19.4%). 72.3% (n = 34/47) of patients were able to continue their anti-TNF therapy without any changes. 8.5% (n = 4/47) continued the anti-TNF at a different dose or interval, 12.8% (n = 6/47) switched to a different anti-TNF agent, and 6.8% (n = 3/47) discontinued anti-TNF therapy altogether.Conclusions:
This is the first study to analyze the frequency of dermatologic complications from anti-TNF therapy in a large pediatric IBD patient group. Psoriasiform lesions were the most prevalent of the reaction types in this cohort, in contrast to adult studies, where infections are more prevalent. In our study, females had more skin reactions than males. The majority of children were able to continue their anti-TNF therapy, but those who developed psoriasis were more likely to switch agents than those with infections or eczema. Further multicenter studies are needed to validate these findings.