Indexed on: 28 May '19Published on: 29 Mar '19Published in: Journal of pediatric gastroenterology and nutrition
In adult inflammatory bowel disease (IBD) treated by anti-TNF antibodies, paradoxical psoriasis has an estimated prevalence of 1.6 to 22%, especially in infliximab (IFX)-treated patients. Little is known in the pediatric IBD (PIBD) populations. All patients aged from 2 to 18 years with Crohn's disease (CD) or Ulcerative colitis (UC) and treated for the first time by IFX between January 2002 and March 2014, were considered for inclusion in this retrospective study performed in a tertiary PIBD centre. Paradoxical psoriasis events together with clinical and biological data were collected in all patients. Comparisons between psoriasis and control groups were performed using univariate statistical analyses. 123 CD patients and 24 UC patients were treated with IFX. 20 patients (13.6%) experienced a paradoxical psoriasis. All of them were affected by CD. Perianal CD was more frequent in the psoriasis group (p = 0.033). 14 patients (70%) were in remission when skin lesions occurred. Paradoxical psoriasis was diagnosed 355 days (median, IQR: 239; 532) after the initiation of IFX corresponding to the 8th injection (median, IQR: 6; 15). Psoriasis lesions were controlled by local steroids in all cases and no patients discontinued IFX therapy. 13.6% of our IBD patients treated with IFX developed psoriasis during a median follow-up of 23.9 months (IQR: 11.6; 36.5). CD patients with perianal disease were at a higher risk to develop this common side effect.