Anti-TNF antibodies play an important role in the management of IBD, rheumatologic diseases, psoriasis. They have a good safety profile but many studies have reported some adverse reactions. Skin manifestations are the most common adverse events and occur in 20¿25% of patients (pts). There are only few data on cutaneous manifestations during anti-TNF¿ therapy in IBD children.
The purpose of our study is to describe cutaneous adverse events in a cohort of pediatric pts receiving biological therapy for IBD. We conduct an observational study among IBD patients follow at our Unit receiving anti-TNF¿ therapy (Infliximab, IFX or Adalimumab, ADA).Therapy duration, time of onset, type(s) and location of skin manifestation, concomitant use of immunomodulators (IM) and corticosteroids(CS), severe systemic events will report. Pts with skin manifestations will refer to a dermatologist for a more accurate diagnosis.
Biological therapies increase the risk of extra-intestinal manifestations of IBD,and joints and skin are the most frequent localizations. In this regard, few papers about skin manifestations in IBD pediatric patients treated with anti-TNFa have been published.In the literature it is reported a prevalence of psoriasis in subjects with IBD between 5-10%, regardless of treatment. The study of Mattozzi et al (2012) suggests that at the base of both pathological conditions can exist a unique mechanism of deregulation of the immune response at the level of "barrier organs" such as the skin and the gastrointestinal mucosa.Genetic factors contribute to this abnormality of function, such as alterations of genes coding for proteins involved in immune function (NOD2, ß defensin etc) and environmental cofactors such as microbial infections, the latter facilitated by its alteration of the integrity of the organs barrier.Infections of the intestinal mucosa may activate lymphocytes residents cross-reactive with molecular elements of keratinocytes that later would lead to skin lesions. In this context it is clear what could be the role of anti-TNF in the pathogenesis of psoriasis.The alteration of the balance of cytokines that derives from their use could be a trigger for the development of cutaneous manifestations that might otherwise not occur. The higher prevalence of psoriasis in
individuals in biological therapy supports this hypothesis which, however, cannot be confirmed without the aid of appropriate molecular studies.The anti TNF¿ are often used for the treatment of psoriasis but they themselves can determine the appearance of psoriatic lesions in subjects treated for both forms of psoriasis, either with other treatment indications. The first cases of psoriasiform rash during treatment with anti-TNF, have been reported from Verea et al Wollina et al in 2008 described 120 adult patients, of which only 21% with a family history of psoriasis and 7% with a personal history of the disease. However there are conflicting data about the real incidence of psoriasis in patients treated with anti-TNF, ranging from 8.4% of Cullen et al. to 75% of a French meta-analysis.These differences could be shown to be other design work reviewed, with possible recall bias for retrospective studies, both at different criteria for defining the group of patients with psoriasis. In the literature, it is reported a large latency variables but in most cases between 10 and 20 months. Cleyen et al reported an average latency of injuries ranging from 12 to 17 months, Denadai et al, months, while Schmidt et al shows an average latency between 12 and 17.6 months depending on the specific anti-TNF used. Numerous cases of discontinuation of therapy for the appearance of psoriasis are reported in the literature. In a study, on 69 cases of psoriasis in the course of biological therapy, it is given a percentage of discontinuation of 50.7%.In almost all subjects who discontinued therapy, there was an improvement of skin manifestation but all patients followed a specific therapy for the treatment of psoriasis among patients who have not stopped treatment, there was an improvement in over 39% of cases. In another prospective pediatric study, only 17 % cases of psoriasis discontinued anti-tnf¿, due to skin reaction.We will evaluate the association between anti-TNF¿ therapy and the onset of skin manifestations in pediatric IBD and the frequency of cutaneous lesions, in order to guide therapeutic decisions of clinician.Pts with skin manifestations will refer to a dermatologist for a more accurate diagnosis.Further researches are needed to quantify the real incidence and the impact of this phenomenon on clinical practice in pediatric patients with IBD.
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