Cutaneous Lupus Erthyematosus and Anti-TNF-α Therapy: A Case Report With Review of the Literature

Anti-tumor necrosis factor-α (TNF-α) immunotherapy is revolutionizing the treatment of immune disease, particularly Crohn’s disease, rheumatoid arthritis, psoriatic arthritis and psoriasis. The role of anti-TNF-α agents in the management of cutaneous lupus erythematosus (LE), however, is not as clear. While experimental reports have suggested a potential benefit of anti-TNF-α therapy in severe cutaneous LE, newer reports have identified these medications as instigators or exacerbators of the disease. In this review, the authors present a case of a patient whose persistent discoid LE (DLE) was exacerbated by a trial of adalimumab, one of the currently available TNF-α-blocking agents. The authors review 128 cases in the literature in which anti-TNF-α therapy was implicated in cutaneous LE pathogenesis, with emphasis on DLE, and consider a number of mechanisms whereby this arguably paradoxical effect may occur. The authors then propose possible approaches to the management of anti-TNF-α therapy-induced cutaneous LE.