Psoriasis in Inflammatory Bowel Disease: When Skin Treatment Does Not Achieve Clearance During TNF Inhibitor Therapy

This protocol addresses patients with inflammatory bowel disease (IBD) who are currently receiving tumor necrosis factor inhibitor (TNFi) therapy and have developed a psoriasiform skin eruption — and in whom an initial skin-directed approach did not produce clearance.

Inflammatory Bowel Disease TNF Inhibitor Therapy Psoriasiform Eruption

There is an established association between IBD and psoriasis, and patients with IBD on TNFi therapy might develop new-onset psoriasiform eruptions.

Previous Step — Did Not Achieve Skin Clearance

The initial approach — treating the skin with psoriasis medications while continuing the IBD medication (with interleukin-17 inhibitor therapy avoided given the IBD) — did not result in resolution of the psoriasiform eruption. This failure to reach skin clearance prompts escalation to the next step.

Next Step & Clinical Goal

When initial skin measures fail, the structured protocol turns to the question of the ongoing TNFi therapy itself. The clinical goal is skin clearance — full resolution of the psoriasiform eruption. The approach involves a considered decision regarding the current TNF inhibitor… the complete structured regimen is behind the link below.

Instant Access to Structured Evidence-Based Regimens

References

There is an established association between IBD and psoriasis, and patients with IBD on TNFi therapy might develop new-onset psoriasiform eruptions.

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

View source ↗