Introduction

Skin disorders as extra-intestinal manifestations of inflammatory bowel disease (IBD) are well recognised. In addition, contribution of drugs used in IBD in development of skin cancers is now fully understood. However, there are increasing reports of drug induced immune skin disorders resulting from or contributed by anti TNF agents. We aim to describe the aetiology, manifestations and therapeutic approaches of anti TNF induced skin eruptions from a large tertiary centre cohort.

Methods

A prospective database of IBD patients receiving biologics for IBD was interrogated for those who developed skin eruptions following initiation of anti-TNF therapy. We excluded patients who had pre-existing skin manifestations. All patients had dermatological expert review and confirmation of diagnosis as drug induced skin disorder. We collected their disease characteristics, time interval from initiation of biologics to development of skin disorder, the putative causative agent and the treatment of the skin lesions.

Results

Eighty-four patients (5%) among 1498 patients (median age= 32 years, Female 53, male 31) who received at least one dose of biologics developed a drug induced immune skin disorder. Median duration to development of skin lesions was 12 months. Anti TNF agents were responsible for 88.5% of the skin lesions with the commonest lesions being psoriasiform lesions in 53 (63%) patients. In our cohort, the psoriasiform lesions were more prevalent in patients who used biosimilar anti-TNF agents compared to the originator agent (45 vs 4). Forty- eight patients required cessation of anti TNF agents because of skin eruptions. Thirty-six of these were switched to ustekinumab with resolution of skin eruptions in 35 patients.

Conclusions

Anti TNF induced psoriasiform skin lesions are not uncommon and appear to be more prevalent in the biosimilar era. Half of these patients will need treatment switch; ustekinumab appears to be an effective option in these patients.

P125 Anti TNF induced psoriasiform skin eruptions are increasing in the biosimilar era