Clinical Scenario

This protocol addresses new-onset psoriasiform skin eruptions in patients with Inflammatory Bowel Disease who are currently receiving tumor necrosis factor inhibitor (TNFi) therapy. There is an established association between IBD and psoriasis, and patients on TNFi therapy may develop these eruptions as a paradoxical cutaneous reaction.

Clinical Goal

Resolution of the psoriasiform eruption and achievement of skin clearance, while maintaining effective control of the underlying inflammatory bowel disease.

Treatment Approach (Partial)

The approach involves treating the psoriasiform skin eruption with therapies used for psoriasis, while continuing the patient's IBD medication. Importantly, one class of therapy commonly used in psoriasis is specifically contraindicated in this setting and must be avoided.

The complete drug selection, sequencing, and clinical algorithm are available in the full structured protocol.

References

There is an established association between IBD and psoriasis, and patients with IBD on TNFi therapy might develop new-onset psoriasiform eruptions.
Patients who develop psoriasiform eruptions while on TNFi therapy might respond to other medications that are used to treat psoriasis and continue on their IBD medication.
Interleukin 17 inhibitor therapy should be avoided in patients with IBD.
If those measures do not improve the psoriasiform eruption, discontinuation of TNFi therapy might be necessary to achieve skin clearance.

DOI: 10.1016/j.jaad.2018.11.058

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Psoriasis in Inflammatory Bowel Disease: Psoriasiform Eruption During TNF Inhibitor Therapy

References