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Skin injuries associated with biological therapy in inflammatory bowel disease: Beyond psoriasis
Lesiones cutáneas con fármacos biológicos en la enfermedad inflamatoria intestinal: más allá de la psoriasis
Alejandro Mínguez Sabater
, Sara Martínez Delgado, Pablo Ladrón Abia, Guillermo Bastida
Corresponding author
Sección de Gastroenterología, Departamento de Medicina Digestiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Larger lesion in the form of localised hyperkeratosis (black arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 43-year-old man with Crohn’s disease of the ileum and colon. He was treated initially with steroids and azathioprine and then with adalimumab (ADA). He remained stable until four years ago, when he developed complex perianal disease (PAD). As ADA failed to manage his PAD, he was started on vedolizumab (VDZ) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The treatment with VDZ brought both his bowel signs and symptoms and his PAD under control. After three years of this treatment, the patient developed a pruriginous palmar–plantar hyperkeratotic maculopapular rash. In his family history, he had a brother with psoriasis. Dermatology diagnosed him by serology with secondary syphilis; he responded well to antibiotic treatment.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Biological drugs are a commonly used treatment tool in inflammatory bowel disease. Their adverse effects include the development of psoriasiform lesions, classically reported with TNF inhibitors, though also with other drugs such as VDZ.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> In many cases, the drug has to be discontinued; therefore, a good differential diagnosis of these lesions with infectious diseases such as syphilis is essential.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> The characteristic sign of secondary syphilis is palmar–plantar involvement manifesting as erythematous papules with a scaly collarette that may take on a psoriasiform appearance. Nail involvement is rare. Treatment does not require discontinuation of the biological drug, but rather antibiotic therapy with penicillin.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that they received no funding to conduct this study.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Mínguez Sabater A, Martínez Delgado S, Ladrón Abia P, Bastida G. Lesiones cutáneas con fármacos biológicos en la enfermedad inflamatoria intestinal: más allá de la psoriasis. Gastroenterol Hepatol. 2022;45:62–63.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 996 "Ancho" => 750 "Tamanyo" => 86001 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Palmar–plantar involvement in the form of erythematous papules with a hyperkeratotic scaly collarette that may take on a psoriasiform appearance. Larger lesion in the form of localised hyperkeratosis (black arrow).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cumulative incidence of, risk factors for, and outcome of dermatological complications of anti-TNF therapy in inflammatory bowel disease: a 14-year experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Fréling" 1 => "C. Baumann" 2 => "J.F. Cuny" 3 => "M.A. Bigard" 4 => "J.L. Schmutz" 5 => "A. Barbaud" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ajg.2015.205" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2015" "volumen" => "110" "paginaInicial" => "1186" "paginaFinal" => "1196" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26195181" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psoriasis induced by vedolizumab" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Sody" 1 => "A. Körber" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Inflamm Bowel Dis" "fecha" => "2017" "volumen" => "23" "paginaInicial" => "9" "paginaFinal" => "11" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of secondary syphilis mimicking palmoplantar psoriasis in HIV infected patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.J. Bittencourt" 1 => "A.C. Brito" 2 => "B.A. Nascimento" 3 => "A.H. Carvalho" 4 => "M.D. Nascimento" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/abd1806-4841.20153399" "Revista" => array:6 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2015" "volumen" => "90" "paginaInicial" => "216" "paginaFinal" => "219" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26312721" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Secondary syphilis presenting as palmoplantar psoriasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Gianfaldoni" 1 => "G. Tchernev" 2 => "U. Wollina" 3 => "R. Gianfaldoni" 4 => "T. Lotti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3889/oamjms.2017.087" "Revista" => array:6 [ "tituloSerie" => "Open Access Maced J Med Sci" "fecha" => "2017" "volumen" => "5" "paginaInicial" => "445" "paginaFinal" => "447" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28785328" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Concurrent lip chancre and maculopapular syphilides in a patient under anti-TNFα therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Lopes" 1 => "M. Costa-Silva" 2 => "S. Magina" 3 => "M. Silva" 4 => "F. Margo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Skinmed" "fecha" => "2019" "volumen" => "17" "paginaInicial" => "343" "paginaFinal" => "345" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31782712" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004500000001/v1_202202060539/S2444382421002376/v1_202202060539/en/main.assets" "Apartado" => array:4 [ "identificador" => "75461" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images of the month" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004500000001/v1_202202060539/S2444382421002376/v1_202202060539/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382421002376?idApp=UINPBA00004N" ]
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