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P578 Therapeutic strategies in the approach of paradoxical psoriasis in IBD: experience of a centre

S. Santos*1, V. Gamelas2, D. Carvalho2, C. Bernardes2, J. Saiote2, J. Ramos2

1Centro Hospitalar Lisboa Central EPE, Gastroenterology, Lisboa, Portugal, 2Centro Hospitalar Lisboa Central, Lisboa, Portugal


Induction of psoriasis with the use of TNFα antagonists, also used in its treatment, is a phenomenon described in inflammatory bowel disease. We intended to analyse predictive factors for the development of this entity and results of the different strategies in its treatment.


Analysis of a cohort under treatment with anti-TNFα between 2005 and 2018. Patients who developed paradoxical psoriasis following onset of anti-TNFα, confirmed by Dermatology were compared with the group without occurrence of cutaneous lesions with treatment. Statistical analysis was performed using SPSS.


291 patients were treated with anti-TNFα, of which 18 (6.2%) developed paradoxical psoriasis. Of these, 13 (72%) were female, with a mean age of 36 years. The majority were under infliximab (n = 14, 78%) and had Crohn's disease (n = 16, 88%). Extra-intestinal manifestations were present in 9 patients (50%) and the mean time until the development of paradoxical psoriasis was 2.8 years (1 month-10 years). Only 3 patients (16.6%) had active disease and 9 (50%) had perianal disease. From the studied variables, female gender and history of extra-intestinal manifestations were associated with the development of psoriatic lesions (p < 0.05). Topical and/or systemic therapy was used, with anti-TNFα being initially maintained, in 14 patients, with improvement of cutaneous lesions in 10 (partial improvement in 6). Anti-TNFα discontinuation was necessary in 7 patients: 2 due to recurrence of psoriasis after reintroduction of anti-TNFα; 2 for recurrence after switch and 3 for absence of skin lesions resolution despite systemic therapy. Swap to ustekinumab was made in 7 patients: complete resolution of the lesions was observed in 6 patients and partial improvement in 1 patient partial, whom maintaining adjuvant systemic therapy. Intestinal remission was maintenance/attainment in all patients.


In this cohort the development of paradoxical psoriasis in inflammatory bowel disease under anti-TNFα was 6.2%, with a higher prevalence in females and in the presence of extraintestinal manifestations. Definitive anti-TNFα suspension was required in 7 patients (38.8%) and the swap strategy was effective in most cases.