Section : Conference Notes

Biologic Therapy for Psoriasis: Paradoxical Reactivation of Psoriasis on Infliximab

  • Infliximab is an anti-TNF biologic
  • It is used in the treatment of rheumatoid arthritis, psoriasis and inflammatory bowel disease

A case report from Spain:

  • 32 year old female known for Crohn’s disease
  • no response to mesalazine and systemic corticosteroids
  • was subsequently put on infliximab at a dosage 5mg/kg for a duration of 10 years
  • she developed severe psoriasiform plaques covering entire scalp accompanied with alopecia
  • biopsy confirmed diagnosis of psoriasis
  • The patient improved with topical steroids, vitamin D analogues and methotrexate 15mg subcutaneously weekly. Anti-TNF treatment was stopped.


  • there are currently over 200 cases of suspected TNF antagonist induced or exacerbated cases of psoriasis in the literature.
  • In this case, reactivation was after 10 years of treatment. The cause is unknown but on suggested mechanisms include:
    • the activation of nascent autoreactive T-cells
    • disruption in cytokine balance by TNF blockade, allowing unopposed interferon-alpha production by plasmacytoid dendritic cells in genetically predisposed individuals
  • there are currently no guidelines on how to change treatments in this situation.


Dr Christophe Hsu – dermatologist. Geneva, Switzerland

Source of information: p317 Development of severe scalp psoriasis and alopecia during treatment of Crohn’s disease with infliximab: a paradoxical side effect. Martinez Peinado C. et al. EADV Annual Meeting (2014), Amsterdam The Netherlands