Introduction
Dermal lesions are often among patients with inflammatory bowel diseases (IBD), partialy could be associated with biological therapies [1,2]. Their occurrence frequently leading to dermatological consultations and causes diagnostic and therapeutic difficulties [3,4].
Aims & Methods
This is a retrospective, single-center analysis of occur dermal lesions in IBD patients treated with TNF at a tertiary center in Poland. A total of 541 IBD patients treated with TNF (case group) and 805 IBD patients without TNF therapy (control group) were included in the study since 2016 till 2022 in the study. The mean follow-up time last in the case group 19.86 vs. 20.78 months in the control group, p<0,46.
Results
Regular visits to the dermatologist during observation were performed in 531 (98,15%) cases vs. 92 (11.43%) controls, p<0,00001. Dermal lesions were presented in 34.75% (188) vs. 16.89% (136) during follow up, p<0,00001. The following dermal lesions were reported in the both groups: erythema nodosum 10 (1.8%) vs. 21 (2.6%), p<0,36; pyoderma gangrenosum 14 (2.58%) vs. 17 (2.11%), p p<0,57; psoriasis 9 (1.66%) vs. 9 (1.12%), p<0,39; hidradenitis suppurativa 9 (1.66%) vs. 15 (1.86%), p<0,79; vitiligo 4 (0.74%) vs. 5 (0.62%), p<0,79; phlebitis 1 (0.18%) vs. 1 (0.12%), p<0,78; urticaria 5 (0.92%) vs. 11 (1.37%), p<0,46; infusion reactions and injection site reaction 30 (5.55%) vs. 0 (0%)0, p<0,00001; xerosis and eczema 46 (8.5%) vs. 44 (5.47%), p<0,28; cutaneous infections 42 (7.76%) vs. 0 (0%), p<0,00001; psorasiform reactions 8 (1.48%) vs. 0 (0%), p<0,002; cutaneus malignancies 2 (0.37%) vs. 9 (1.12%), p<0,13; lupus-like symptoms 4 (0.74%) vs. 0 (0%), p<0,07; vasculitis 1 (0.18%) vs. 0 (0%), p<0,77; alopecia areata / totalis 2 (0.37%) vs. 2 (0.25%), p<0,96; lichenoid drug reactions 2 (0.37%) vs. 0 (0%), p<0,35. In 9 (1.66%) cases anti-TNF therapy led to drug change because of dermal lesions (alopecia, lupus-like syndrome, vasculitis or melanoma).
Conclusion
Dermal lesions during TNF therapy are common and often require dermatological consultation. Despite the lack of clear guidelines on dermatological supervision during biological therapy, its regular conduct seems to be justified and may facilitate the initiation of appropriate management at an early stage. Despite the commonness of dermal lesions, they are rarely the reason for changing treatment.
References
1. Antonelli E, Bassotti G, Tramontana M et al. Dermatological Manifestations in Inflammatory Bowel Diseases. J. Clin. Med. 2021; 10, 364.
2. Lambert J.L.W, De Schepper S, Speeckaert, R. Cutaneous Manifestations in Biological-Treated Inflammatory Bowel Disease Patients: A Narrative Review. J. Clin. Med. 2021; 10, 1040.
3. Cleynen I, Van Moerkercke W, Billiet T, et al. Characteristics of Skin Lesions Associated With Anti-Tumor Necrosis Factor Therapy in Patients With Inflammatory Bowel Disease: A Cohort Study. Ann Intern Med. 2016; 164: 10-22.
4. Summaries for Patients. Rashes in Patients With Ulcerative Colitis or Crohn Disease Being Treated With Drugs That Block Tumor Necrosis Factor. Ann Intern Med. 2016; 164. doi: 10.7326/P16-9000. Epub 2015 Dec 8.