Novel posterior auricular cutaneous reaction after anti–TNF-α infusion in young women with Crohn's disease

CD: Crohn’s disease IBD: inflammatory bowel disease TNF: tumor necrosis factor INTRODUCTION Tumor necrosis factor (TNF)-a is a cytokine critical for effective immune surveillance. Abnormally elevated TNF has been implicated in the pathogenesis of many inflammatory conditions. Anti-TNF medications are an effective targeted therapy for these conditions. Cutaneous reactions after treatment with anti-TNF medications have been well documented in the literature. Complications include hypersensitivity reactions, psoriasiform eruptions, lupuslike syndrome, and cutaneous vasculitis. The mechanism for these paradoxical immune reactions is unclear. One hypothesis is that blocking TNF-a leads to unopposed production of interferon-a, a cytokine frequently implicated in the induction of autoimmunity. We present 7 patients with inflammatory bowel disease (IBD) who had cutaneous reactions characterized by painful, fissured, erosive plaques in the postauricular region after treatment with anti-TNF therapy. After this rash, several of these patients subsequently had a similar eruption in the scalp associated with prominent alopecia.