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A Crohn's related skin question

Hello friends! H is dealing with a weird skin issue. We took her to a GP who diagnosed it as a fungal infection and we are treating it as such but it does not itch. After a few weeks if she fails treatment we will go back for second look.
Meanwhile, my mommy brain is really worried it may be Humira induced psoriasis or just....psoriasis.
She has it in patches on different parts of both legs....just small dry patches that are developing into larger redder areas.
She has high trough levels of Humira, and this past year has dealt with a few unusual secondary type infections.
If anyone has experience with psoriasis and how it starts...I could be way off here. But I know there are kids who have both diagnoses and more.
 
Hi Pilgrim - our mommy brains always seemto be working! I believe that itchiness always is a part of psoriasis. There is obviously a skin thing going on but it could be something else (not psoriasis). My niece has psoriasis and and itchiness always is part of the package. @crohnsinct and @Maya142 will probably be able to help you as I think their daughters had/have psoriasis from taking biologics.

Big hug.
 

Maya142

Moderator
Staff member
I don't think itchiness is always part of psoriasis - my husband was just diagnosed with psoriasis and he never complained of itching. His is scalp psoriasis but he also has nail psoriasis, which was misdiagnosed as a fungal infection for years. My younger daughter also has nail psoriasis but nowhere else on her body. Nail psoriasis is definitely not itchy!

Here are some pics of the different types of psoriasis: https://www.aad.org/public/diseases/psoriasis/what/symptoms

I do think you need to see a dermatologist to see the rash. A GP may not be able to distinguish between eczema, psoriasis and a fungal infection. I know several kiddos who have arthritis, whose psoriasis was misdiagnosed as eczema. Nail psoriasis is also something to watch for because it is strongly associated with psoriatic arthritis. These are some pictures of nail psoriasis: https://www.aad.org/public/diseases/psoriasis/treatment/genitals/nails

You do have to zoom in to see nail changes properly on that page. That site also has a comparison between psoriasis and eczema, under the "What is psoriasis" tab.

Definitely take pictures!! Rashes tend to magically disappear the day of your appt. ;)!!
 
Lol! That seems to be true for many ailments (disappearing day of appointment).

Good advice. I will check the link. Thank you so much.
 

crohnsinct

Well-known member
Hmmm. Both my girls have psoriasis but that dry and scaly on the legs it would usually itch for my two but true O has had it on occasion on her arms and it didn't itch BUT it also wasn't scaly or dry.

HOWEVER, both girls have also had numerous fungal breakouts on their skin that looked exactly like psoriasis that we treated with cortisone creams and they didn't go away so off to derm we went only to find out it was never psoriasis at all and fungal. The anti tifs leave people susceptible to fungal infections and the skin is not exempt from that.

I second Maya's suggestion of a dermatologist visit and even then dermatologists can even misdiagnose things. O's psoriasis was misdiagnosed for a long time as eczema by a dermatologist!
 
Hello friends! H is dealing with a weird skin issue. We took her to a GP who diagnosed it as a fungal infection and we are treating it as such but it does not itch. After a few weeks if she fails treatment we will go back for second look.
Meanwhile, my mommy brain is really worried it may be Humira induced psoriasis or just....psoriasis.
She has it in patches on different parts of both legs....just small dry patches that are developing into larger redder areas.
She has high trough levels of Humira, and this past year has dealt with a few unusual secondary type infections.
If anyone has experience with psoriasis and how it starts...I could be way off here. But I know there are kids who have both diagnoses and more.
hi friend ,i was on humira for sometime and i alway got alot of chest infection and rash on my neck ,i posted some information on humira on my page called crohnsdigest http://crohnsdigest.net/ hopefully this might help
regards pj
 
Can I ask what you're treating it with?

I have chronic scalp, neck and shoulder fungal acne outbreaks (most likely a malasezia) and I believe chron's makes us more susceptible.

I have to be careful in any kind of shampoo, conditioner, hair styling cream, lotion, etc. I use in order to not get break-outs. It took me a long time to find the cause and it wasn't until I went on a strict avoidance of fungus-promoting products.

This had me eliminate all oil-containing products except mineral oil.

My top treatments have been nizorale shampoo and de la cruz sulfur ointment (stinky, drying, but potent).

You could likely use pure mineral oil to keep it from drying too much, or, and this may sound weird, I've been able to use Mizon snail repair gel (made from snail secretions) without getting a reaction.

Some types of fungus can be very stubborn and even trace amounts of a food product can allow them to flourish, such as an oil low on the ingredient list.

I found that many OTC anti-fungal products did not work for me, such as lotramin, and other dermatitis or topical antimicrobial treatments made it worse, such as things with tea tree, zinc oxide creams, salicylic acid, benzyl peroxide, etc.


So it may NOT be fungal and that's why it's not responding, or it may be EXTREMELY stubborn fungus that requires very strict product use.
 
Can I ask what you're treating it with?

I have chronic scalp, neck and shoulder fungal acne outbreaks (most likely a malasezia) and I believe chron's makes us more susceptible.

I have to be careful in any kind of shampoo, conditioner, hair styling cream, lotion, etc. I use in order to not get break-outs. It took me a long time to find the cause and it wasn't until I went on a strict avoidance of fungus-promoting products.

This had me eliminate all oil-containing products except mineral oil.

My top treatments have been nizorale shampoo and de la cruz sulfur ointment (stinky, drying, but potent).

You could likely use pure mineral oil to keep it from drying too much, or, and this may sound weird, I've been able to use Mizon snail repair gel (made from snail secretions) without getting a reaction.

Some types of fungus can be very stubborn and even trace amounts of a food product can allow them to flourish, such as an oil low on the ingredient list.

I found that many OTC anti-fungal products did not work for me, such as lotramin, and other dermatitis or topical antimicrobial treatments made it worse, such as things with tea tree, zinc oxide creams, salicylic acid, benzyl peroxide, etc.


So it may NOT be fungal and that's why it's not responding, or it may be EXTREMELY stubborn fungus that requires very strict product use.
We are treating it with Terbafine Hydrochloride (Lamasil). The doctor said that we need to treat it for at least two weeks before thinking it isn't working. I tried an OTC medication first but only for 5 days and it appeared to get worse. We'll see if this one works. I will give it more time.
 
I talked to the Humira people who advised holding off on injections until the infection clears. Last month she had a weird bacterial infection which also needed us to hold Humira for a few weeks.

Once we resumed Humira, she developed the fungal infection within 2 weeks.

Her trough levels are very high. This pattern gives me pause to think we need to talk to GI about decreased dosing. But no, she is not in remission. Not doing badly but not in remission.
 
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my little penguin

Moderator
Staff member
I know your system is different
Can she see a derm who has experience with people on biologics
We have found that makes a big difference for skin issues .
Ds had foliculitus , molluscum and plantar warts while on humira
A lot less skin issues on Stelara
But having a good derm is also key to getting things taken care of quickly
 
It's possible she could see a derm. It would take many months.
Last month they thought she had Impetigo. She also had plantar warts for so long....they disappeared when she had to take antivirals for shingles a year ago.
How long has he been on Stelara? Is it still building or at therapeutic levels?
Our GI has mentioned Stelara.
 

my little penguin

Moderator
Staff member
He started Stelara in August 2017 so 2.5 years
After 8 months there was minor inflammation on the scopes but his joints were still bad so they increased to 90 mg every 4 weeks in March 2018 and has stayed there since with fecal cal below 15( not detectable) blood work completely normal range
He is on a second biologic (another condition) plus mtx for arthritis.
Only issue is plantar warts every once in a while

How old is she now ?
Under 12 is harder to get it approved and prescribed .

We were told crohns of the small intestine does “ok” with Stelara but the colon doesn’t fair as well on it
That said arthritis typically does not do well in studies on Stelara (dosing is much lower abd farther out ) but his Rheumo states that the combo of higher plus mtx has really helped put his joints with no active disease .

Newer IL-23 only drugs are supposed to be better but they are still phase II or III for adults with crohns so it will be a while ...
 
Can I ask what you're treating it with?

I have chronic scalp, neck and shoulder fungal acne outbreaks (most likely a malasezia) and I believe chron's makes us more susceptible.

I have to be careful in any kind of shampoo, conditioner, hair styling cream, lotion, etc. I use in order to not get break-outs. It took me a long time to find the cause and it wasn't until I went on a strict avoidance of fungus-promoting products.

This had me eliminate all oil-containing products except mineral oil.

My top treatments have been nizorale shampoo and de la cruz sulfur ointment (stinky, drying, but potent).

You could likely use pure mineral oil to keep it from drying too much, or, and this may sound weird, I've been able to use Mizon snail repair gel (made from snail secretions) without getting a reaction.

Some types of fungus can be very stubborn and even trace amounts of a food product can allow them to flourish, such as an oil low on the ingredient list.

I found that many OTC anti-fungal products did not work for me, such as lotramin, and other dermatitis or topical antimicrobial treatments made it worse, such as things with tea tree, zinc oxide creams, salicylic acid, benzyl peroxide, etc.


So it may NOT be fungal and that's why it's not responding, or it may be EXTREMELY stubborn fungus that requires very strict product use.
hi i thave alot of scail and hair danfruf that when bad fall on to the skin and get very sore i do not use any shampo with alchol in it and it hepls
 
He started Stelara in August 2017 so 2.5 years
After 8 months there was minor inflammation on the scopes but his joints were still bad so they increased to 90 mg every 4 weeks in March 2018 and has stayed there since with fecal cal below 15( not detectable) blood work completely normal range
He is on a second biologic (another condition) plus mtx for arthritis.
Only issue is plantar warts every once in a while

How old is she now ?
Under 12 is harder to get it approved and prescribed .

We were told crohns of the small intestine does “ok” with Stelara but the colon doesn’t fair as well on it
That said arthritis typically does not do well in studies on Stelara (dosing is much lower abd farther out ) but his Rheumo states that the combo of higher plus mtx has really helped put his joints with no active disease .

Newer IL-23 only drugs are supposed to be better but they are still phase II or III for adults with crohns so it will be a while ...
She is only 9 years old yet....last scopes showed active duodenal disease. She had fcal in the 400s last check but asymptomatic. She may not be the right candidate for Stelara.

Also hoping to avoid returning to Mtx due to severe headaches on that med.
 
hi i thave alot of scail and hair danfruf that when bad fall on to the skin and get very sore i do not use any shampo with alchol in it and it hepls
I suggest getting Nizorale shampoo, massage onto the scalp with no water and let sit 20 minutes. Do this daily for 1 week.

Then 3 times a week for the remainder of the month.

See if it clears.

Avoid conditioners and shampoos with oils and esthers. Very hard to do, but possible.
 
I had some skin problems before when I was on Pentasa, but they were relatively minor. Once on Humira, however they increased a lot.

This makes sense, I suppose, since they say biologics compromise your immune system. The skin is the body's biggest organ, and evidently first to start to crumble with these drugs. I would not only get itchy, scaly spots, but I got hard spots below and they eventually erupted into pimple like things that burst, accompanied by lots of pain. I eventually learned to handle them with Hibiclens or something like it daily, covered by a bandaid with antibiotic cream. Sometimes bigger bandaids. Under the arms and groin were the hardest to deal with, but these eruptions happened all over.

Moving to Entyvio, with less systemic impact, was expected to help and it has. But the problem IS NOT GONE, just less frequent. I can't stress enough how important Hibiclens is in preventing and catching them early. There's also a product called Aloe Vestra that's used without water, and I like that a lot too.
 

my little penguin

Moderator
Staff member
@JackG
Did you ever have them biopsied ? See a Derm
Humira and other biologics can “unmask “ secondary skin conditions
A good derm will know what is related to the biologic and what is related to crohns
Sweets syndrome and PG are both associated with crohns and can cause lesions
 
Yes, I have had them biopsied, and was told they are psoriasis. Frankly, though they gave me a med that helps (see pic), I'm not sure how much to believe since their first recommendation was HUMIRA. Isn't it funny how it can help in one person and aggravate another? In my case there's no question Humira helped my Crohns but accelerated my psoriasis. I saw the increase and I saw the decrease when I went off of it.
 

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crohnsinct

Well-known member
@JackG if Hibiclens works they could be folliculitis. At least that is what they sound like. Especially in the areas you are getting them. I get them and I don't have IBD nor am I on any meds.
 

crohnsinct

Well-known member
Oh o.k. just saw our post. My girls both have Triamcinolone. It sorta helps them. The scalp is hard to treat. They both use Fluocinolone oil (derma Smooth). It helps some.
 

crohnsinct

Well-known member
Hibiclens exacerbates my girls' psoriasis because it is very drying to the skin. It does help if their patches are infected though.
 
Six months ago, my husband began to itch some areas on his legs and face in this way. We thought it was psoriasis, but still decided to go to the doctor. After a series of tests, it turned out to be skin cancer. It was a tragedy for our family. What, it was necessary to do the operation and we went to the clinic that conducts Mohs surgery, this method is considered the most effective, up to 99%. Fortunately for us, there was no relapse and my husband is fine. I would like to tell you, study your symptoms better and always get your second opinion about the diagnosis.
 
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Hello again! H had another round of skin issues lately. The patch on her leg never healed, just grew a bit, and we had a return of the skin issue behind her ear where it attaches to her head. Also a facial rash like breakout.

This time we had pics sent to a dermatologist who diagnosed all of it as eczema. Although he said it looked like it might be a type that is caused by biologics. She has a prescription for tacrolimus cream, as well as calcipotriol cream for her leg.

Just curious if anyone has had Humira induced eczema. I didn't know that was a thing.
 

my little penguin

Moderator
Staff member
Ahhh
Ds had the peeling cracking thing where his ear attached to his head -derm had a specific name for it wasn’t eczema though ....
On humira
But it went away even before he switched to Stelara

facial rash he had with remicade -went away when he stopped remicade

I would check with Gi on the tacromilus cream (elidel ??)
One of the creams increased lymphoma so Gi put a hard no on it
But had no problem with Ds using other stuff

right now he has severe acne - given her age (10 right ??) it could be that as well
We were told puberty is extremely difficult for these kids - chemical changes needed for puberty increase inflammatory levels so disease control is beyond hard
Things like acne which is inflammation based can show up much worse than normal teen version and be a warning sign for flares
For ds this is true

he also has cracking skin between his fingers
Still fingering that one out .

hope the creams help her
Eczema is tough
Look up wet wraps and eczema

That can help
 

crohnsinct

Well-known member
Don't take that eczema diagnosis to the bank just yet. That is what they told O she had also. Not a lot of terms are great at diagnosing anti tnf induced psoriasis. I would wait until you could get her into the office and they could do a proper exam. That area behind the ear is a famous spot for psoriasis.

The treatment she is on is pretty typical for psoriasis also. Yes, there is a black box warning on the tacro and we asked our GI about it and between the derm who said that black box warning on the topical is old and doesn't really apply anymore and the GI who said relatively the same, my girls kept using it. O practically bathes in it. Is she using tacro on her face? There is actually a really safe and good cream for the face....T was on it for both her Vitaligo and her psoriasis. I forget the name but will ask her when she comes home.
 
Yeah, that spot behind the ears was E's biggest location for Remicade-induced psoriasis. Is H still off methotrexate? E's psoriasis started up when she went off mtx, and went away completely when she went back on it.
 
Yes. H is off Mtx. The skin issues popped back up when her Humira levels were raised to 80mg and we dropped MTX at the same time. So that is very interesting.
 
@my little penguin She could be starting puberty but she isn't dealing with acne. I have a call into GI to double check the treatment for her skin.

Also to see if the sinus problem which cleared up with antibiotics and then returned 24hrs after she finished the course is a Humira problem. That also cropped up within 2 weeks or so of dose change...
 

my little penguin

Moderator
Staff member
Remember for puberty the chemical changes that start the inflammation cascade start long before the physical changes can be seen .
 
@my little penguin my son C is 12 and H is 10, they are flaring together. As girls mature faster than boys they might be on track to deal with inflammation in tandem as they mature. A 2 for 1 deal on Crohn's flares.

GI asked for the derm report to go over the reasoning for the Tacrolimus cream. GI thinks Humira/Sinusitis are unrelated.

GP ordered another week of antibiotics for the sinus infection. Pharmacist said one week is never enough for a sinus issue.

Hoping another week does the trick.
 
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Maya142

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Staff member
he also has cracking skin between his fingers
Still fingering that one out .
M has this too! She also has a rash on the back of her hands which appears right before Cimzia is due and goes away about 2 days after she has Cimzia. Her rheumatologist thinks it's eczema but wants her to see a dermatologist to be sure. It covers her knuckles and goes up her fingers to the middle joint. I don't think it looks like traditional plaque psoriasis but for some reason, Cimzia clears it.

Don't take that eczema diagnosis to the bank just yet. That is what they told O she had also. Not a lot of terms are great at diagnosing anti tnf induced psoriasis. I would wait until you could get her into the office and they could do a proper exam.
I hadn't realized even derms don't always know the difference between eczema and psoriasis! Yikes! We'll get a referral from her rheumatologist then rather than seeing a local dermatologist.

H could definitely be starting puberty - girls can start pretty early. My daughter got her period at 11. She didn't have any acne till she was older though - probably when she was around 13.
 

crohnsinct

Well-known member
Yeah @Maya142 I think it is easy for them to lump everything into the eczema category and for the most part that is o.k. as the drugs are usually the same BUT it becomes important to distinguish between eczema and psoriasis as psoriasis has many more repercussions and things you have to watch out for and if you already have an auto immune disease the addition of psoriasis means more than eczema.

Actually, I have psoriasis. Very mild. But when I met with the GI about me potentially having Crohn's he said that with people who have psoriasis and have a first degree relative with Crohn's they can get Crohn's like inflammation and symptoms but it won't actually be Crohn's. Interesting.

O's psoriasis has had implications for her liver in that psoriasis actually does something in the liver where it can cover up potential damage done to the liver so certain blood tests will yield a false normal reading.
 

Maya142

Moderator
Staff member
But when I met with the GI about me potentially having Crohn's he said that with people who have psoriasis and have a first degree relative with Crohn's they can get Crohn's like inflammation and symptoms but it won't actually be Crohn's. Interesting.
This is true of AS too - it's very common to have subclinical gut inflammation that resembles Crohn's. It's generally just inflammatory disease - ulcers but no strictures or fistulae or anything serious. Like 70% of patients have it! They tend to have no symptoms. But it only turns into IBD for a tiny proportion of those patients - like 5% or so.

How do dermatologists tell the difference between eczema and psoriasis? Do they do a biopsy?
 
Hi, I just searched Psoriasis on the forum because I too have developed a rash. I have Crohn's and AS, started on Amgevita Adalimumab (Humira) October 2020, nearly 18 months ago. All fine, no problems. I had my 1st Covid vaccine Feb 2021 and 2 weeks later developed tiny spots on my arms, legs and feet. The doctor and the rheumatologist didn't know if the Covid vaccine or the Adalimumab was to blame so I was advised to stop the adalimumab for a few weeks. The doctor thought it was Pityriasis Rosea, gave me a liquid soap to use for 2 weeks which didn't work. The spots joined together and formed a hard, red, scaly rash on the top of my feet and shins.

The doctor then said it was either guttate psoriasis or discoid eczema so gave me a steroid cream to use - this worked but as soon as I stopped using it the rash came back. I had my second Covid vaccine in the meantime so the Rheumatologist has asked me to restart Adalimumab, as that would also treat Psoriasis, but stop the steroid cream. They want to see if the rash gets worse/better with me just using Adalimumab.

So far, I have had 2 injections and the rash is no worse but no better either . I have been referred to a Dermatologist as nobody is sure what it is and whether it is caused by vaccine or adalimumab. Any advice or opinions gratefully received thank you!
 
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I don't have advice but just want to encourage you to keep us posted. My daughter has her first pediatric dermatologist appointment in September 2021 so I will also post what we learn here -and we can help others who come along.
 
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crohnsinct

Well-known member
@CH1 My daughters with Crohn's both have psoriasis. At first it was thought that it was Remicade induced as some people have a paradoxical reaction to the anti tnf's but now they aren't sure. My older daughter has very severe Crohn's and got very severe psoriasis. She also uses lots of creams and oils and such. They don't make it go away but they do lessen it and just like you when you don't treat it, it comes back. The dermatologist told us that switching meds only fixes the psoriasis in about 50% of the cases and advised us to stick with Remicade given her Crohn's had more serious outcomes if it were underrated. We played with the dose a lot trying to see if there was a level where it wouldn't be so bad but nothing worked. WE added methotrexate as that is sometimes used to treat psoriasis. There is another mom on here who has a daughter who that worked for. Paging @pdx . It didn't help my girls. Years later we dropped the anti tnf and switched her to Entyvio and no clearing of the psoriasis. She has also now added Humira and it is worse than ever.

FWIW - when we first tried to treat with creams the plan was to use them every day for two weeks then slowly taper until we found the frequency that works best. So after the two weeks we did every other day, then every two days etc. The hope was we would get to once a week.
 
Yes, my daughter's psoriasis completely cleared with methotrexate added to her treatment. Hope the dermatologist can figure out what's going on.
 

Lisa

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Location
New York, USA
I still have skin issues since @2010-12.....started really after a couple bouts of strep, ended up with what looked like Gutatte psoriasis, which appears to have turned into inverse psoriasis...I also get small scaly spots here and there, lower back/buttocks, ankles, which do clear up if I use a steroid cream. So far no definitive diagnosis, and I do see a dermatologist at least once per year for a check up. I did have a skin scraping/biopsies taken years ago and they came back negative for any fungal infection, or psoriasis.....
 

Lady Organic

Moderator
Staff member
I also had a skin issue around both my eyes a few months ago. Thought maybe caused by Humira. It lasted about 2-3 months. Reddish and itchy. It looked to me like eczema which I had a lot of experience with as a child (bilateral on inner elbows and knees, sometimes hands), but never on my face. Always had minor issues with scalp as an adult, probably seborrheic dermatitis.
I started treating the eye skin issue on my own with a steroid cream I had. It worked but would return very fast into endless cycles. The pharmacist told me the cream I was using was too strong for eye area, so i stopped. before making a medical appointment, i decided to try tea tree essential oil mixed with hypollergenic cream and applied 3 to 4 times a day. I felt right away it was calming the itchiness. it worked as well as the steroid cream. It took a good month for the cycle to end. Its been a good while now those itchy spots have not returned, 2 months at least.
 
Thanks all for your replies - much appreciated. My OP should have said Oct 2019, sorry. The Rheumy wants to switch me to Stelara as that treats Psoriasis as well as Crohns & AS, however I am reluctant as I have had no issues whatsover with Adalimumab, unless of course it is that causing the rash and not the Covid vaccine. I will wait for the Derma appt and see what transpires!
 

my little penguin

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TNF Inhibitors Linked to Threefold Increased Risk of Psoriasis in JIA Patients
Tara Haelle
April 29, 2021
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Children with juvenile idiopathic arthritis (JIA) have nearly triple the risk of developing psoriasis after they begin therapy with tumor necrosis factor (TNF) inhibitors, according to preliminary research shared at the annual meeting of the Childhood Arthritis and Rheumatology Research Alliance (CARRA).

Dr Yongdong (Dan) Zhao
Previous retrospective research at the Children's Hospital of Philadelphia had found similar results, so the goal of this study was to look at prospectively collected data from the CARRA registry that represented a broader patient population than that of a single institution, lead author Yongdong (Dan) Zhao, MD, PhD, assistant professor of rheumatology at the University of Washington, Seattle, and pediatric rheumatologist at Seattle Children's Hospital, said in an interview.

"The take-home message is that we confirmed this finding, and everyone who prescribed this should be aware [of the risk] and also make the family aware because often the family just thinks this is eczema and they self-manage without reporting it to the physician," Zhao said. He advised that physicians look for evidence of psoriasis at visits and, depending on the severity, be prepared with a management plan if needed.

The researchers analyzed data from patients with JIA enrolled in the CARRA registry during June 2015–January 2020. They excluded patients with a diagnosis of inflammatory bowel disease, psoriasis at or before their JIA diagnosis, or missing data regarding the timing of psoriasis diagnosis or starting TNF inhibitors.
Among 8,222 children (29% of whom were male), just over half (54%) had ever used TNF inhibitors. Most of the patients (76%) were White, and their average age at the time of JIA diagnosis was 7 years. Compared to those with no exposure to the drugs, patients who had ever been prescribed a TNF inhibitor were three times more likely to receive a diagnosis of psoriasis afterward (unadjusted hazard ratio [HR] = 3.01; P < .01). The risk dropped only slightly (HR = 2.93; P < .01) after adjustment for gender, race, family history of psoriasis, initial International League of Associations for Rheumatology classification category, and ever having taken methotrexate.
Overall median follow-up time for the cohort was 46.7 months. The overall incidence of psoriasis in the cohort was 5.28 cases per 1,000 person-years, which split into 3.24 cases for those never exposed to TNF inhibitors and 8.49 for those ever exposed. The incidence was similar (8.31 cases per 1,000 person-years) after only the first course of TNF inhibitors.

Dr Pamela Weiss

TNF inhibitors are first-line biologic treatment for JIA and have a longer track record for safety and effectiveness than that of newer drugs, Zhao said. They're also commonly used for children with psoriasis, said Pamela Weiss, MD, associate professor of pediatrics and epidemiology, at the University of Pennsylvania, Philadelphia, and clinical research director of rheumatology at Children's Hospital of Philadelphia. She was not involved in the study.

"TNF inhibitors are an incredibly useful class of medications for children with arthritis, including psoriatic arthritis," Weiss said in an interview. "I don't think these findings impact the risk-benefit profile of TNF inhibitors as paradoxical psoriasis is a known side effect of the medication and something most of us already counsel our families and patients about before starting a TNF inhibitor medication."
Zhao likewise did not think the findings changed these drugs' benefit-risk profile as long as people are aware of it. If the psoriasis is mild, he said, it's often possible to continue the TNF inhibitor therapy along with a topical medication for the psoriasis, "but if it's really severe, or by patient preference, you may have to switch to a different TNF inhibitor or stop it," he said. Occasionally, he has added an additional biologic to treat the psoriasis because the underlying JIA disease in the patient couldn't be controlled without the TNF inhibitor.
Weiss similarly said that management will depend on the severity and on shared decision-making between the physician, patient, and family.
"If it's a small area, it can often be managed with topical corticosteroids," Weiss said. "If it involves a large area of the body or severely affects the scalp, then stopping the TNF inhibitor therapy and starting another therapy that targets a different pathway might be considered."

The research was funded by CARRA. Zhao has received research funding from Bristol-Myers Squibb and has consulted for Novartis. Weiss has received consulting fees from Pfizer and Lilly.
From
 

Lady Organic

Moderator
Staff member
Thanks all for your replies - much appreciated. My OP should have said Oct 2019, sorry. The Rheumy wants to switch me to Stelara as that treats Psoriasis as well as Crohns & AS, however I am reluctant as I have had no issues whatsover with Adalimumab, unless of course it is that causing the rash and not the Covid vaccine. I will wait for the Derma appt and see what transpires!
yes really best to take time before switching a medication that works, as changing can create more complications including relapse and no garantee to same response with other medication. Skins issues are often mysterious. The dermo will be aware of possible skin reactions after the vaccine too maybe.
At the begining of the pandemic I also had an issue on both my hand's fingers, little annoying hard bubbles formed on my fingers, just a bit itchy. Not responding to steroid cream. After 3 months, they just disappeared, never came back. Then this eye skin issue responding to steroid cream and then thankfully, to tea tree oil.
A lot of skin issues can come and go. If minor and bearable, patience can pay with end of the inflammatory cycle eventually.
 

my little penguin

Moderator
Staff member
Same here
My kiddo has had skin issues
Derm advised to keep using heavier hitters for crohns /arthritis and she would just fix the skin
Word of caution Stelara did not do well in trials for AS
The only reason Ds is permitted to even be on Stelara is his crohns . His juvenile arthritis is still ERA and doesn’t have spinal involvement
Even then he requires high frequency of Stelara plus mtx to keep the arthritis under control
 

crohnsinct

Well-known member
SAME! And my daughter has pretty hideous psoriasis but she also has severe Crohn's and spent an entire summer in the hospital the last time she had to switch drugs because what she was on stopped working. She says she would rather be a scaling, itching mess than deal with the Crohn's issues. But everyone is different and the incidence of depression is extremely high in people with psoriasis. People in public star at my daughter.
 

Maya142

Moderator
Staff member
@CH1 Stelara does NOT treat AS. My daughters both have AS - one very severe (she had her first joint replacements at 22) and one with moderate AS. My younger daughter, M, (who has severe AS) has failed pretty much every med out there. We have done extensive research on Stelara - she sees two major AS researchers and her primary rheumatologist is a psoriatic arthritis researcher and M is in several studies. ALL the rheumatologists we have ever seen have said Stelara does NOT work well for AS and doesn't even work well for psoriatic arthritis. It does not work for spinal disease. It might for peripheral joints like your knees or fingers, but definitely not for the sacroiliac joints and spine. All IL-23 inhibitors have failed so far in AS.
You are much better off on a TNF inhibitor like Humira or Remicade.
AS can become very aggressive and difficult to treat. I would be hesitant to switch from a drug that is working.
 
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