תגובות עוריות לנוגדי tnf בקרב חולי מחלת מעי דלקתית: תובנות ממרפאה מולטידיסציפלינרית

BACKGROUND
Dermatological manifestations are common among patients with inflammatory bowel diseases (IBD) treated with anti-tumor necrosis factor agents (ATNFs). As the diagnosis and treatment of dermatologic manifestations is often challenging, we established a multidisciplinary referral clinic (IBD-DERMA) for joint decision making and patient care.

METHOD and AIMS
We aimed to estimate the impact of multidisciplinary care in the IBD-DERMA clinic. Consecutive patients with IBD who have developed a dermatological complication of ATNFs were included. Mann Whitney or Chi- square tests were employed to compare continuous or categorical variables, accordingly.

RESULTS
Overall, since 2018, 92 patients referred to the clinic (54.3% males, median age 34 years. Crohn’s disease - 75 and ulcerative colitis -16 patients), 78.5% were treated with ATNFs. The most prevalent dermatologic diagnosis was skin eruptions induced by ATNF (42 patients): 28/42 patients with psoriasiform dermatitis (PD), and 14/42 patients with dominant inflammatory alopecia (IA). Discontinuation of the offending ATNF was necessary in 93% of the patients with IA compared to 36% of patients with PD (p<0.001). A switch to a different biologic class was needed in order to control either the skin condition and/or the IBD in 57.1% of the IA patients, compared to only 10.7% of patients with PD (p=0.002).

CONCLUSIONS
Psoriasiform skin eruptions were the most prevalent diagnoses. Almost a third of the patients presented with dominant IA secondary to ATNF, a condition that has a distinct course, and may represent a unique pathophysiologic process. Joined decision making has resulted in improvement in 88% of dermatologic manifestations