Methotrexate for psoriasiform lesions associated with anti-tumour necrosis factor therapy in inflammatory bowel disease

Background Psoriasiform lesions associated with anti-tumour necrosis factor (TNF) therapy are frequent in patients with inflammatory bowel disease (IBD). While methotrexate is the most frequently used systemic treatment for psoriasis, its efficacy for psoriasiform lesions related to anti-TNF therapy remains unknown. Aims To assess the efficacy of Methods The charts of eight patients from the Nancy IBD cohort who developed psoriasiform lesions on anti-TNF therapy were reviewed. Clinical response was defined as a decrease of more than 50% in the lesions covering surface. All patients were followed up by the same experienced dermatologist. Results Eight women (seven Crohn's disease) were followed up for a median duration of 29 months (range, 20-45). Of the eight patients receiving methotrexate, three were primary responders without discontinuation of anti-TNF agents. Only one patient had a sustained response at final follow-up and was able to continue both methotrexate and anti-TNF therapy. Of the two other primary responders, one patient had to discontinue anti-TNF because of severe psoriasiform lesions, whereas the other one continued anti-TNF therapy despite persistent skin lesions at final follow-up. Among the five primary nonresponders, four patients had to stop anti-TNF treatment due to disabling skin lesions.