{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T09:40:37Z","timestamp":1793353237769,"version":"4.5.0"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"<jats:sec id=\"ab-dbr230003-4\"><jats:title>Importance<\/jats:title><jats:p>Tumor necrosis factor \u03b1 (TNF) inhibitor\u2013induced psoriasiform eruption is well recognized in adults, but few reports document this paradoxical effect in children.<\/jats:p><\/jats:sec><jats:sec id=\"ab-dbr230003-5\"><jats:title>Objective<\/jats:title><jats:p>To characterize the clinical features and the clinical time course of TNF inhibitor\u2013induced psoriasiform eruptions in children.<\/jats:p><\/jats:sec><jats:sec id=\"ab-dbr230003-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>A multicenter retrospective case series of children younger than 18 years seen between January 1, 2000, and December 31, 2016, who developed a new-onset psoriasiform eruption while taking a TNF inhibitor for a nondermatologic disorder. Participating sites were members of the Pediatric Dermatology Research Alliance. Data were entered into a Research Electronic Data Capture database at the Mayo Clinic (ie, the coordinating center).<\/jats:p><\/jats:sec><jats:sec id=\"ab-dbr230003-7\"><jats:title>Results<\/jats:title><jats:p>Psoriasiform eruptions were identified in 103 TNF inhibitor\u2013treated patients (median age, 13.8 years [IQR, 11.7-16.4 years]; 52 female patients [50%]; 57 White patients [55%]), with 67 patients (65%) treated with infliximab, 35 (34%) with adalimumab, and 1 (1%) with certolizumab pegol. Most patients had no personal history (101 [98%]) or family history of psoriasis (60 patients [58%]). Inflammatory bowel disease was the most common indication for treatment with TNF inhibitor (94 patients [91%]). The primary extracutaneous disease was under control in 95 patients (92%) who developed the eruption. Most patients (n\u2009=\u200985 [83%]) developed psoriasiform eruptions at multiple anatomic sites, with scalp involvement being most common (65 patients [63%]). Skin disease developed at a median of 14.5 months (IQR, 9-24 months) after TNF inhibitor initiation. To treat the psoriasiform eruption, topical steroidal and nonsteroidal medication was prescribed for all patients. Systemic therapy was added for 30 patients (29%): methotrexate for 24 patients (23%), oral corticosteroids for 8 patients (8%), and azathioprine for 1 patient (1%). For 26 patients (25%), suboptimal effectiveness with topical medications alone prompted discontinuation of the initial TNF inhibitor and a change to a second-line TNF inhibitor with cutaneous improvement in 23 patients (88%) by a median of 3 months (IQR, 2-4 months). Eight patients (31%) who started a second-line TNF inhibitor developed a subsequent TNF inhibitor\u2013induced psoriasiform eruption at a median of 6 months (IQR, 4-8 months). Persistent skin disease in 18 patients (17%) prompted discontinuation of all TNF inhibitors; 11 patients changed to a non-TNF inhibitor systemic therapy, and 7 discontinued all systemic therapy.<\/jats:p><\/jats:sec><jats:sec id=\"ab-dbr230003-8\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this case series, paradoxical TNF inhibitor\u2013induced psoriasiform eruptions were seen in children treated with TNF inhibitors for any indication, and there appears to be a class effect among the varying TNF inhibitors. The majority of these children were able to continue TNF inhibitor therapy with adequate skin-directed and other adjuvant therapies.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamadermatol.2023.0549","type":"journal-article","created":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T15:02:11Z","timestamp":1681311731000},"page":"637","source":"Crossref","is-referenced-by-count":18,"title":["Paradoxical Psoriasiform Eruptions in Children Receiving Tumor Necrosis Factor \u03b1 Inhibitors"],"prefix":"10.1001","volume":"159","author":[{"given":"Joshua","family":"Eickstaedt","sequence":"first","affiliation":[{"name":"Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy S.","family":"Paller","sequence":"additional","affiliation":[{"name":"Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, 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Faith","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Pediatrics, Ohio State University College of Medicine, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen E.","family":"Holland","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Medical College of Wisconsin, Milwaukee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Ibler","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilyn G.","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia S.","family":"Todd","sequence":"additional","affiliation":[{"name":"Division of Pediatric Dermatology, Department of Pediatrics, University of Louisville, Louisville, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine","family":"Siegfried","sequence":"additional","affiliation":[{"name":"Division of Pediatric Dermatology, Department of Pediatrics, Saint Louis University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Igelman","sequence":"additional","affiliation":[{"name":"Wright State University School of Medicine, Dayton, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly M.","family":"Cordoro","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Division of Pediatric Dermatology, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megha M.","family":"Tollefson","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Mayo Clinic, Rochester, Minnesota"},{"name":"Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"11","key":"dbr230003r1","article-title":"Anti-TNF agents for paediatric psoriasis.","volume":"2015","author":"Sanclemente","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"issue":"11-12","key":"dbr230003r2","doi-asserted-by":"publisher","first-page":"1318","DOI":"10.1111\/apt.2011.34.issue-11-12","article-title":"Psoriasis associated with anti-tumour necrosis factor therapy in inflammatory bowel disease: a new series and a review of 120 cases from the literature.","volume":"34","author":"Cullen","year":"2011","journal-title":"Aliment Pharmacol Ther"},{"issue":"5","key":"dbr230003r3","doi-asserted-by":"publisher","first-page":"e179","DOI":"10.1016\/j.jaad.2011.05.038","article-title":"Psoriasis and palmoplantar pustulosis associated with tumor necrosis factor-a inhibitors: the 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