Biological therapy for dermatological manifestations of inflammatory bowel disease

Abstract

Ulcerative colitis and Crohn’s disease are the two forms of inflammatory bowel disease (IBD). The advent of biological drugs has significantly changed the management of these conditions. Skin manifestations are not uncommon in IBD. Among the reactive lesions (immune-mediated extraintestinal manifestations), erythema nodosum (EN) and pyoderma gangrenosum (PG) are the two major cutaneous ills associated with IBD, while psoriasis is the dermatological comorbidity disease observed more often. In particular, in the last few years, anti-tumor necrosis factor (TNF)-α agents have been successfully used to treat psoriasis, especially these kinds of lesions that may occur during the treatment with biological therapies. The entity of the paradoxical manifestations has been relatively under reported as most lesions are limited and a causal relationship with the treatment is often poorly understood. The reason for this apparent side-effect of the therapy still remains unclear. Although side effects may occur, their clinical benefits are undoubted. This article reviews the therapeutic effects of the two most widely used anti-TNF-α molecules, infliximab (a fusion protein dimer of the human TNF-α receptor) and adalimumab (a fully human monoclonal antibody to TNF-α), for the treatment of the major cutaneous manifestations associated with IBD (EN, PG and psoriasis).

Keywords: Biological therapies; Erythema nodosum; Inflammatory bowel disease; Psoriasis; Pyoderma gangrenosum

Core tip: Ulcerative colitis and Crohn’s disease are the best known forms of inflammatory bowel disease (IBD) and are considered immune-mediated disorders of unknown etiology that primarily affect the gastrointestinal tract. In addition, other organ systems can be involved, such as skin. Erythema nodosum, pyoderma gangrenosum and psoriasis are the dermatological comorbidities often associated with it. The anti-tumor necrosis factor (TNF)-α drugs (infliximab and adalimumab) have significantly changed the management of these conditions. In this brief review, we provide an overview on the prevalence and clinical aspects of the more commonly reported skin manifestations of IBD and the role of TNF-α inhibitors in their treatment.