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Interstitial Granulomatous Dermatitis Associated With the Use of Tumor Necrosis Factor  Inhibitors
April Deng, MD, PhD;
Valerie Harvey, MD;
Bahram Sina, MD;
David Strobel, MD;
Ashraf Badros, MD;
Jacqueline M. Junkins-Hopkins, MD;
Allen Samuels, MD;
Mana Oghilikhan, MD;
Anthony Gaspari, MD
Arch Dermatol. 2006;142:198-202.
Background Tumor necrosis factor  (TNF-) has been implicated in the pathogenesis of numerous inflammatory and autoimmune disorders. Accordingly, TNF- inhibitors, such as thalidomide, infliximab (Remicade), adalimumab (Humira), and etanercept (Enbrel), have been used with success in the treatment of autoimmune disorders, including psoriasis, rheumatoid arthritis, inflammatory bowel diseases, and lymphoproliferative disorders. Although anti–TNF- therapy is safe and well tolerated, various adverse cutaneous reactions have been reported.
Observations We encountered 5 patients who developed erythematous annular plaques on the trunk and extremities while receiving 4 different medications with inhibitory activity against TNF-. One patient was treated with lenalidomide (Revlimid) for multiple myeloma, 2 received infliximab, and 1 received etanercept for severe rheumatoid arthritis; the last patient was in a clinical trial of adalimumab for psoriatic arthritis. Skin biopsy specimens revealed diffuse interstitial granulomatous infiltrates of lymphocytes, histiocytes, and eosinophils, palisading degenerated collagen. Withdrawal of the medications led to complete resolution of the skin lesions.
Conclusion Interstitial granulomatous dermatitis should be considered in the differential diagnosis of skin lesions occurring in the setting of anti–TNF- therapy.
Author Affiliations: Departments of Dermatology (Drs Deng, Harvey, Sina, Strobel, and Gaspari) and Radiation Oncology (Dr Badros), University of Maryland, Baltimore; Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia (Dr Junkins-Hopkins); Department of Rheumatology, Temple University Hospital (Dr Samuels), Philadelphia; and Department of Dermatology, Georgetown University, Washington, DC (Dr Oghilikhan).
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