From the Guidelines
Infliximab can cause several skin-related side effects, including injection site reactions, rashes, and increased risk of skin infections, and patients should be closely monitored for these adverse events, as they can be severe and potentially life-threatening 1.
Common Side Effects
- Injection site reactions, such as redness, pain, swelling, or itching at the site where infliximab is administered
- Rashes, which can range from mild to severe, including psoriasiform eruptions
- Increased risk of skin infections due to its immunosuppressive effects
- Increased sun sensitivity (photosensitivity)
Serious Side Effects
- Drug-induced lupus, which presents with a butterfly-shaped rash on the face
- Stevens-Johnson syndrome or toxic epidermal necrolysis, which are rare but life-threatening conditions characterized by widespread skin peeling and blistering
- New-onset psoriasis or worsening of existing psoriasis in some patients
Management of Side Effects
- Mild to moderate side effects can be managed with topical therapies or systemic therapies with antihistamines or short courses of systemic steroids
- Severe cases require interruption or temporary reduction of infliximab, and in some cases, permanent withdrawal of the medication
- Patients should report any skin changes to their healthcare provider promptly, as some reactions may require discontinuation of the medication or additional treatment 1
Risk Factors
- Patients with a history of malignancy or current or recent past history of malignancy should be cautious when using infliximab, as it may increase the risk of cancer 1
- Patients with a history of tuberculosis or other infections should be closely monitored, as infliximab may increase the risk of reactivation of these infections 1
From the FDA Drug Label
Erythema multiforme, Stevens-Johnson Syndrome, toxic epidermal necrolysis, linear IgA bullous dermatosis (LABD), acute generalized exanthematous pustulosis (AGEP), worsening psoriasis (all subtypes including pustular, primarily palmoplantar), lichenoid reactions The side effects of infliximab on the skin include:
- Erythema multiforme
- Stevens-Johnson Syndrome
- Toxic epidermal necrolysis
- Linear IgA bullous dermatosis (LABD)
- Acute generalized exanthematous pustulosis (AGEP)
- Worsening psoriasis (all subtypes, including pustular, primarily palmoplantar)
- Lichenoid reactions 2 2
From the Research
Side Effects of Infliximab on the Skin
The use of infliximab, a monoclonal anti-Tumor Necrosis Factor alpha-antibody, has been associated with various cutaneous side effects. Some of the common skin reactions include:
- Xerosis cutis
- Eczema (often psoriasiform)
- Psoriasis
- Palmoplantar pustulosis
- Cutaneous infections
- Alopecia
- Skin cancer 3 These reactions typically occur months to years after the initiation of treatment.
Risk Factors for Cutaneous Side Effects
Certain factors have been identified as risk factors for infliximab-induced cutaneous side effects, including:
- Smoking
- Female sex
- Crohn's disease 3
Pathophysiology of Cutaneous Side Effects
The underlying pathophysiology of infliximab-induced cutaneous side effects is still poorly understood. However, several factors are thought to contribute to these reactions, including:
- Epidermal permeability barrier dysfunction
- Increased susceptibility to bacterial superinfection
- Cytokines derived from T helper (Th) 1, Th17 cells, plasmocytic dendritic cells, and keratinocytes 3
Case Reports of Infliximab-Induced Skin Reactions
Several case reports have been published describing infliximab-induced skin reactions, including:
- A 59-year-old woman who developed an atypical erythematosus rash, inflammatory syndrome, and high levels of anti-DNA antibodies after receiving infliximab for rheumatoid arthritis 4
- A patient who developed pustular psoriasis after receiving infliximab for intraocular inflammation 5
- A patient who developed impetigo contagiosa induced by Staphylococcus aureus after receiving infliximab for intraocular inflammation 5
Management of Cutaneous Side Effects
In some cases, the discontinuation of infliximab may be necessary to manage cutaneous side effects. However, in other cases, premedication and/or decreased infusion rate may be sufficient to allow continued treatment with infliximab 6. Desensitization protocols have also been used to successfully manage infliximab-induced systemic reactions, including cutaneous side effects 6