{
  "abstract": "Anti-TNF-alpha therapies are effective for treating inflammatory bowel disease (IBD) but can be associated with dermatologic complications, including infections, psoriasis, and eczema. 1–3 While there are reports of anti-TNF-related skin reactions in IBD, data specific to paediatric populations are limited.2 4 Recognizing and managing these skin manifestations early is essential to optimize care for this population.We conducted a retrospective review of six paediatric patients with IBD who developed anti-TNF-induced skin manifestations. Collected data included patient demographics, IBD phenotype, type of dermatologic reaction, anti-TNF dosing, clinical interventions, and outcomes.The patients, aged 8–14 years, included an equal number of females and males. Five (83%) had Crohn’s disease, and one (17%) had ulcerative colitis; all were on infliximab at the time their skin reactions developed. Cutaneous reactions included psoriatic lesions on the knees, elbows, legs, and scalp (1 patient); lesions on the ears (3 patients); nostril involvement (2 patients); scalp lesions (2 patients); and inner breast area lesions (1 patient). These findings illustrate the broad range of possible skin manifestations, which can vary significantly in distribution and severity.1 4 5 All patients were receiving infliximab with dosing ranging from 5 mg/kg to 10 mg/kg and infusion intervals between 4 to 8 weeks. Infliximab trough levels were typically below 10 mg/mL though one patient had levels exceeded 15 mg/mL. Most lesions were identified as inflammatory or infective, with one case diagnosed as psoriasis. Treatment included topical steroids (mometasone, clobetasone) in 90% of cases, and all patients received antibiotics at the initial stage of skin involvement. Only one patient required discontinuation of infliximab.Our findings suggest that paediatric IBD patients can develop anti-TNF-induced skin reactions without a personal or family history of dermatologic conditions, posing a diagnostic and management challenge.3 5 Importantly, these reactions may appear even when IBD is well-controlled, making decisions regarding continuation or cessation of therapy more complex.2 4 Physicians should maintain a high index of suspicion for anti-TNF-induced dermatologic manifestations in paediatric IBD patients who present with new or unusual skin lesions. Assessing infliximab trough levels may help in evaluating whether higher concentrations contribute to skin reactions, though further research is needed to establish a definitive link.5 Clinicians should consider early dermatologic consultation and weigh the benefits and risks of continuing anti-TNF therapy considering these potential adverse effects, particularly when IBD control is stable but dermatologic complications arise.By identifying and managing these skin reactions proactively, healthcare providers can better support the overall therapeutic goals for paediatric IBD patients, optimizing treatment outcomes and patient quality of life.References Reinhart JP, Aird JL, Stephens MC, Asch S. Tumor necrosis factor-alpha inhibitor-induced morphea and psoriasiform dermatitis in a paediatric patient with Crohn’s disease. Journal article 2023.Pollard B, Utterson EC, Samson CM. Immunosuppressant-associated eruptions in paediatric inflammatory bowel disease: a case-control study. Journal article. 2022.Cossio ML, Genois A, Jantchou P, Hatami A, Deslandres C. Skin manifestations in paediatric patients treated with a TNF-alpha inhibitor for inflammatory bowel disease: a retrospective study. Journal of Cutaneous Medicine and Surgery 2020.Shchomak Z, Azevedo S, Rodrigues L, dos Santos CF. Cutaneous manifestation in biological treated Paediatric Inflammatory bowel disease: A 10 years’ experience from a tertiary centre. United European Gastroenterology conference 2022.Ogunmoye O, Perez AZ, Sider S, Buckingham R, Chadokufa S, Ocholi A, Shah. Skin manifestations in Paediatric Inflammatory Bowel Disease (PIBD) patients on monoclonal therapy. Skin manifestations in Paediatric Inflammatory Bowel Disease (PIBD) patients on monoclonal therapy. 2018.",
  "authors": [
    {
      "affiliations": [
        "Maidstone and Tunbridge Wells Hospital"
      ],
      "name": "Abhishek Menon"
    }
  ],
  "title": "OC78 Cutaneous skin manifestations associated with TNF alpha inhibitor in paediatric patients with inflammatory bowel disease: a case series from a district general hospital in the United Kingdom",
  "uid": "9a6a944a-de18-587a-a093-ab6fe19f2d75"
}