Although a tumor necrosis factor (TNF) alpha antagonist can be used to treat psoriasis, it can also trigger or worsen psoriasis. This paradoxical effect may be caused by a drug-induced change in the patient's immune response.


Clinical findings:

(1) current therapy with a tumor necrosis factor antagonist

(2) either exacerbation of skin lesions in a patient with psoriasis or new onset of psoriatic skin lesions in a patient without a history of psoriasis

(3) remission in the skin lesions on discontinuation of the medication


Reappearance of the skin lesions on drug rechallenge strengthens the diagnosis but this may not be attempted.


The severity of the drug-induced psoriasis varies, with some cases severe enough to require discontinuation of the TNF antagonist therapy.


Differential diagnosis:

(1) noncompliance in a patient with psoriasis

(2) non-psoriatic skin eruption


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