The Effectiveness of Tumor Necrosis Factor  Antibody (Infliximab) in Treating Recalcitrant Psoriasis
A Report of 2 Cases
Ryan P. O'Quinn, MD;
Jami L. Miller, MD
Arch Dermatol. 2002;138:644-648.
Background Psoriasis is being recognized as an autoimmune disease in which immunocyte-derived
cytokines are thought to drive the development of the altered keratinocyte
phenotype. Although the role of tumor necrosis factor  (TNF-)
in psoriasis is not completely understood, it may underlie many of the key
steps that lead to induction and maintenance of the disease. Infliximab is
an immunoglobulin monoclonal antibody that binds and inactivates TNF-
and has been successfully used in the management of TNF-–mediated
diseases, such as Crohn disease and rheumatoid arthritis.
Observations Two patients with recalcitrant psoriasis that was unresponsive to multiple
skin-directed and systemic therapies were treated with a single infusion of
infliximab. The treatments resulted in rapid and complete clearing of psoriatic
erythroderma and resolution of symptoms of arthritis in one case and complete
clearing of widespread psoriatic plaques and improvement of symptoms of arthritis
and inflammatory bowel disease in the other. The single treatments with infliximab
were well tolerated with no immediate or long-term adverse effects noted.
Conclusion A single infusion of infliximab at 5 to 10 mg/kg resulted in the rapid
and complete clearing of recalcitrant psoriatic plaques and erythroderma with
a disease-free interval of 3 to 4 months in these 2 patients and improved
the symptoms of psoriatic arthritis.
From the Department of Medicine, Division of Dermatology, Vanderbilt
University, Nashville, Tenn.
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