few patches remaining on her elbows and umbilicus. The psoriatic plaques on her scalp had improved as well, and she noted regrowth of her hair. Methotrexate and phototherapy were then discontinued. One year later, the patient continued to do well. Her Crohn’s disease remained asymptomatic with complete mucosal healing throughout her gastrointestinal tract, as demonstrated by endoscopy and colonoscopy (Figure 2). She continued to have mild erythematous scaly patches on the scalp and ears, however these areas were under better control with topical corticosteroids, and her hair had completely regrown (Figure 3). In the hope of further improving her psoriasis, her dose interval of ustekinumab was then shortened to every 6 weeks and the skin patches completely cleared without any other medications (Figure 4). She has not had any adverse effects from the ustekinumab.
CASE DISCUSSION
TNF inhibitors are used for several pediatric conditions, including
Crohn’s disease and ulcerative colitis. Psoriasiform skin
lesions are a well-documented side effect in up to 5% of patients.
1 There are currently five approved TNF inhibitors in the
United States: etanercept, infliximab, adalimumab, golimumab,
and certolizumab, and all have been associated with this side effect.
The mean time to development is 10-17 months, although
this is highly variable and has been reported years after initiation
of therapy as well.2-4 Sites most commonly affected include
