Family history of psoriasis, psychological stressors, and tobacco use are associated with the development of tumor necrosis factor-α inhibitor-induced psoriasis: A case-control study

Background: Tumor necrosis factor-α inhibitor-induced psoriasis (TNFI-psoriasis) is a paradoxical reaction characterized by development of a psoriasiform rash that mimics psoriasis vulgaris. Temporal onset variability and low incidence rates suggest underlying risk factors and/or outside triggers may play a role in TNFI-psoriasis initiation.

Objectives: We aimed to identify underlying risk factors/outside triggers associated with TNFI-psoriasis onset.

Methods: This case-control study included 97 patients at a tertiary care center between 2003-2013 who developed TNFI-psoriasis. Ninety-seven control patients were matched to age, gender, disease, TNF-α inhibitor, and length of time on treatment prior to TNFI-psoriasis onset. Patient medical records were reviewed 6+ months immediately prior to TNFI-psoriasis onset (similar equivalent time point for matched controls) for information about potential risk factors/outside factors categorized as: (1) serologic abnormalities, (2) acute events, and (3) social factors.

Results: Odds ratios (ORs) were significantly higher in the TNFI-psoriasis group for psoriasis family history (OR=16.0), acute psychological stressors (OR=3.14), and marginally associated with tobacco use (OR=1.76) compared to matched controls.

Conclusions: Our results suggest psoriasis family history, psychological stressors, and tobacco use may be risk factors for developing TNFI-psoriasis. Performing detailed patient histories when considering TNFI therapy may be useful in identifying patients at risk for TNFI-psoriasis.

Keywords: Family History; Paradoxical Psoriasis; Psychological Stress; Risk Factors; Smoking; TNF-α Inhibitor; TNF-α Inhibitor-Induced Psoriasis; Tobacco.