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Exacerbation of psoriatic skin lesions in patients with psoriatic arthritis receiving anti-tumour necrosis factor-alpha therapy: description of 3 cases and review of the literature.

The use of tumour necrosis factor alpha (TNF-alpha) blockade to treat patients with both psoriasis and psoriatic arthritis (PsA) is now well established. However, paradoxical case reports of new-onset or exacerbation of psoriasis during all TNF-alpha blockers therapy have been published. We now review the literature and add a description of three PsA patients whose arthritis had responded well to TNF blockade but in whom major exacerbation of their psoriatic skin lesions occurred.