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- W2020809327 abstract "To the Editor: A 2-day-old black female newborn, born via cesarean section after premature rupture of membranes (34 weeks' gestation), had a collodion membrane. Stellate cracking was present over the entire cutaneous surface (Fig 1). There were no nail abnormalities, bullae, ectropion, or eclabium. The mother was treated for severe psoriasis and psoriatic arthritis with a 7.5-mg/kg infusion of infliximab every 6 weeks throughout pregnancy, and for 6 months before conception. She took no other medications during her pregnancy. Newborn genetic screening, complete blood cell count, and comprehensive metabolic panel test results were within normal limits, and there was no history of consanguinity. There was no family history of bullous congenital ichthyosiform erythroderma or lamellar ichthyosis. Treatment was initiated with a petrolatum-based ointment (Aquaphor, Beiersdorf Inc, Wilton, CT). The collodion membrane shed completely and the skin normalized over 2 months. The skin was normal-appearing at age 1 year. The mean age of onset of psoriasis is during the 20s and 30s, the peak childbearing years. Although the hormonal changes of pregnancy can improve psoriasis, approximately 20% worsen.1Murase J.E. Chan K.K. Garite T.J. Cooper D.M. Weinstein G.D. Hormonal effect on psoriasis in pregnancy and postpartum.Arch Dermatol. 2005; 141: 601-606Crossref PubMed Scopus (135) Google Scholar Psoriatic arthritis, severe in 5% of patients, can be quite destructive. Inflammatory cytokines such as interleukin 17 and tumor necrosis factor (TNF)-alfa inhibit the T-helper cell type 17 axis inducing inflammation and defects in keratinocyte differentiation producing psoriatic plaques.2Wang C.Q.F. Akalu Y.T. Suarez-Farinas M. Gonzalez J. Mitsui H. Lowes M.A. et al.IL-17 and TNF synergistically modulate cytokine expression while suppressing melanogenesis: potential relevance to psoriasis.J Invest Dermatol. 2013; 133: 2741-2752Crossref PubMed Scopus (131) Google Scholar TNF-alfa inhibitors, such as infliximab, are remarkably effective in controlling both psoriasis and psoriatic arthritis.2Wang C.Q.F. Akalu Y.T. Suarez-Farinas M. Gonzalez J. Mitsui H. Lowes M.A. et al.IL-17 and TNF synergistically modulate cytokine expression while suppressing melanogenesis: potential relevance to psoriasis.J Invest Dermatol. 2013; 133: 2741-2752Crossref PubMed Scopus (131) Google Scholar Infliximab, a complete chimeric monoclonal IgG1 antibody, is a potent anti–TNF-alfa biologic agent delivered by infusion. It is designated Food and Drugs Administration (FDA) category B because animal reproduction studies did not demonstrate a risk but well-controlled studies in human pregnancy have not been done.3Carter J.D. Ladhani A. Ricca L.R. Valeriano J. Vasey F.B. A safety assessment of tumor necrosis factor antagonists during pregnancy: a review of the Food and Drugs Administration database.J Rheumatol. 2009; 36: 635-641Crossref PubMed Scopus (229) Google Scholar The Fc receptors on trophoblasts help to actively transport all biological agents with an IgG Fc region. Therefore, the transplacental passage of monoclonal antibodies such as infliximab and adalimumab is greater than in etanercept. An FDA database review of 41 children born to mothers taking a TNF antagonist demonstrated congenital anomalies in 24 children (59%).3Carter J.D. Ladhani A. Ricca L.R. Valeriano J. Vasey F.B. A safety assessment of tumor necrosis factor antagonists during pregnancy: a review of the Food and Drugs Administration database.J Rheumatol. 2009; 36: 635-641Crossref PubMed Scopus (229) Google Scholar Of the anomalies reported, 56% were part of the vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities (VACTERL) spectrum, but only 1 child was diagnosed with VACTERL. A retrospective analysis of pregnancy outcomes of 32 women exposed to anti–TNF-alfa inhibitors demonstrated no increased risk to the patients and fetuses, although the paucity of data precluded a recommendation for regular use in pregnancy.4Hyrich K.L. Symmons D.P.M. Watson K.D. Silman A.J. Pregnancy outcome in women who were exposed to anti–tumor necrosis factor agents: results from a national population register.Arthritis Rheum. 2006; 54: 2701-2702Crossref PubMed Scopus (90) Google Scholar Although collodion membrane associated with anti–TNF biologic agents has not been reported to our knowledge, there are several examples of paradoxical inducement of keratinization abnormalities. New-onset psoriasis has occurred in a series of patients with rheumatologic conditions treated with TNF-alfa inhibitors.5Sfikakis P.P. Iliopoulos A. Elezoglou A. Kittas C. Stratigos A. Psoriasis induced by anti–tumor necrosis factor therapy: a paradoxical adverse reaction.Arthritis Rheum. 2005; 52: 2513-2518Crossref PubMed Scopus (276) Google Scholar, 6De Gannes G.C. Ghoreishi M. Pope J. Russell A. Bell D. Adams S. et al.Psoriasis and pustular dermatitis triggered by TNF-α inhibitors in patients with rheumatologic conditions.Arch Dermatol. 2007; 143: 223-231Crossref PubMed Scopus (299) Google Scholar The pathogenesis of these paradoxical reactions may be the result of overexpression of interferon because of the cross-regulation between TNF-alfa and interferon. Perhaps a similar mechanism may explain the translucent, tight, and parchment paper–like “collodion membrane” in our patient after prenatal exposure to infliximab. Collodion membrane secondary to ichthyoses can be excluded because this child's condition was self-limited. Considering potential side effects of alternative systemic agents, TNF-alfa inhibitors should remain in the armamentarium for pregnant psoriatic patients. Etanercept may be the safest of this class because of its lower level transplacental passage." @default.
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- W2020809327 title "Collodion-like membrane in a newborn exposed to infliximab" @default.
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