238
Eczematiform Lesions
Eczema-like lesions are characterized by xerosis and pruriginous plaques with ery-
thematous or squamous vesicles [ 35 ]. In a retrospective study by Rahier et al., 23
IBD patients were observed to have eczematiform lesions while receiving anti-TNF
therapy [ 25 ]. Of these 23 patients, 10 had a personal history of atopy, 4 reported a
family history of atopy, 1 had a personal history of psoriasis, and 1 had a family
history of psoriasis [ 25 ]. The observed eczematiform lesions were distributed evenly
on the scalp, trunk, face, and flexures [ 25 ]. Histological features of eczematiform
lesions are similar to those of classic eczema, with intercellular edema within the
epidermis and perivascular lymphoid infiltrate [ 25 ]. The authors did not find a dif-
ference in the development of eczematiform lesion according to the IBD type, dis-
ease activity, and the anti-TNF therapy received [ 25 ].
Risk Factors for Psoriasiform and Eczematiform Lesions
Psoriasiform lesions that occur after initiation of anti-TNF therapy are thought to be
an adverse effect of therapy because the majority of patients do not have a personal
or a family history of psoriasis [ 31 ]. In a systematic analysis of cases of psoriasis
induced by anti-TNF therapy for IBD, only 3/21 (14%) had a first- or second-degree
relative with psoriasis [ 31 ]. The age at onset of psoriasiform and eczematiform
lesions during anti-TNF therapy tends to occur in young adulthood [ 25 , 31 , 36 ],
with a median age of 32 years (IQR 24–39) in the psoriasiform group and 31 years
(IQR 23–39) in the eczematiform group (see Table 14.2) [ 25 ].
The majority of patients who develop psoriasiform and eczematiform lesions are
females [ 25 , 31 , 32 , 34 , 36 ]. In a retrospective study consisting of 85 patients who
had new onset or exacerbation of psoriasiform or eczematiform lesions while
Fig. 14.2 Anti-TNF-induced
psoriasiform lesion
U. Wong and R.K. Cross