Reacciones cutáneas psoriasiformes durante el tratamiento con etanercept

Santos-Juanes, J.; Galache, C.

doi:10.1016/S0001-7310(10)70018-1

Article information

Resumen

Los anti-factor de necrosis tumoral (TNF) presentan un amplio espectro de lesiones cutáneas, entre las que se encuentra paradójicamente la psoriasis.

Una mujer de 42 años, con una historia de artritis reumatoidea desde los 19 años, fue remitida al servicio de Dermatología por presentar una psoriasis pustulosa en ambas plantas de los pies durante un tratamiento con etanercept. Ante la presencia de este cuadro se instauró tratamiento corticoideo tópico oclusivo, con mejoría clínica a las 4 semanas y desaparición total de las lesiones a las 6 semanas.

Los anti-TNF son fármacos que actúan en enfermedades mediadas por células T. La aparición de erupciones psoriasiformes es más frecuente de lo comunicado en la literatura, ya que aparecen en todas las indicaciones y con todos los anti-TNF, con mayor frecuencia con adalimumab. Se producen tres tipos de reacciones, siendo la pustulosa la más común; predomina en mujeres y puede aparecer cronológicamente en cualquier momento durante el tratamiento. Respecto al tratamiento es aconsejable continuar con los anti-TNF.

Palabras clave:

Psoriasis

Etanercept

Abstract

Anti-TNFs have a wide spectrum of skin lesions, psoriasis being found among them paradoxically.

A 42-year old woman with a history of rheumatoid arthritis since 19 years of age was referred to the Dermatology service due to pustular psoriasis on both soles during treatment with etanercept. Due to her incapacity to walk and the pain reported by the patient, etanercept was replaced with adalimumab with clinical improvement and total disappearance of the lesions at six weeks of switching the anti-TNF.

Tumor necrosis factor inhibitors are drugs that act in T cell mediated diseases. The appearance of psoriasiform rashes is more frequent than reported in the literature. They appear in all the indications and with all the anti-TNFs. Adalimumab is the most frequent. Three types of reactions are produced, the pustular one being the most frequent. It predominates in women and may appear chronologically at any time during the treatment.

Regarding the treatment, it is recommendable to continue with the anti-TNFs.

Keywords:

Psoriasis

Etanercept

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