Tumor necrosis factor (TNF) and interleukin (IL)-12/23 (ustekinumab) blockade are highly effective treatments for many autoimmune conditions including psoriasis, but rarely these agents can paradoxically induce psoriasiform eruptions.1-4 Interestingly, ustekinumab has been shown to control TNF inhibitor–induced psoriasis,2 and TNF inhibitors have been shown to control ustekinumab-induced psoriasis,4 supporting the hypothesis of multiple pathways in psoriasis with one or the other being most important in an individual patient. If this is true, then if an individual experiences disease flares with one class of biological agent, a treatment response may be achieved with another class.
Sladden MJ, Sladden CS, Gulliver WPF. Secukinumab-Induced Psoriasiform Eruption. JAMA Dermatol. 2017;153(11):1194–1195. doi:10.1001/jamadermatol.2017.2826
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