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Anti-TNF-α-induced psoriasiform lesions in IBD: an abnormal immune activation or a ‘patchy cutaneous’ immune suppression?
  1. Franco Scaldaferri1,
  2. Valentina Petito1,
  3. Alfredo Papa1,
  4. Monica Cesarini2,
  5. Vincenzo Arena3,
  6. Loris Riccardo Lopetuso1,
  7. Maddalena Corbi4,
  8. Francesca Perino5,
  9. Giacomo Caldarola5,
  10. Angelo Carbone5,
  11. Enrico Corazziari2,
  12. Alessandro Sgambato4,
  13. Antonio Gasbarrini1,
  14. Clara De Simone5
  1. 1Gastroenterology Division, ‘Policlinico A. Gemelli’ Hospital, Catholic University of the Sacred Hearth, Rome, Italy
  2. 2Gastroenterology Division, ‘Policlinico Umberto I’ Hospital, University ‘La Sapienza’, Rome, Italy
  3. 3Institute of Pathology, Catholic University of the Sacred Hearth, Rome, Italy
  4. 4Institute of General Pathology, Catholic University of the Sacred Hearth, Rome, Italy
  5. 5Institute of Dermatology, ‘Policlinico A. Gemelli’ Hospital, Catholic University of the Sacred Hearth, Rome, Italy
  1. Correspondence to Professor Antonio Gasbarrini, UOC Medicina Interna e Gastroenterologia, Catholic University of the Sacred Hearth, l.go Gemelli 8, Rome 00168, Italy; agasbarrini{at} and Professor Alessandro Sgambato, Institute of General Pathology, Catholic University of the Sacred Hearth, l.go Francesco Vito 1, Rome 00168, Italy; asgambato{at}

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We read with interest the original article by Tillack et al who reported the characteristics of psoriasiform skin lesions induced by antitumour necrosis factor (anti-TNF)-α in patients with IBD.1 The authors show by immunohistochemical analysis that cutaneous lesions are characterised by interferon (IFN)α expression, infiltrates of interleukin (IL)-17A/IL-22-secreting T helper (Th)17 cells and IFNγ-secreting Th1 cells. They also demonstrate that therapy with ustekinumab, an anti-IL-12/IL-23 antibody, is highly effective in treating anti-TNF-α antibody-induced psoriasis and psoriasiform lesions.

Our group is interested in the pathogenesis of psoriasiform lesions induced by anti-TNF-α antibodies in IBD patients. We found an interesting case of an 18-year-old man diagnosed with ileo-colonic Crohn's disease in 2003. In June 2009, the patient presented with back pain and impaired spinal mobility and was diagnosed with ankylosing spondylitis by lumbar MRI. Since symptoms did not improve with steroids and physiotherapy, he switched to adalimumab (40 mg every other week following 160/80 mg induction …

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  • AS, AG, CDeS, FS, AP and VP contributed equally.

  • Contributors FS, AP, VP, LRL, AG, EC, AS and CDeS wrote, revised the manuscript and analysed data. VP and FS performed culturing of the skin biopsies. VA analysed histopathology. MC performed RT-PCR, Bioplex and analysed these data. FP, GC, AC and CDeS performed the dermatological evaluation, gave informed consent to the patient and performed the cutaneous biopsy. MC and EC clinically managed the patient.

  • Funding This work was supported by PRIN 2008 and Fondazione di Ricerca in Medicina.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Catholic University of The Sacred Hearth, Rome, Italy.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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