113 A Retrospective Case Series of Psoriasis in Patients With Inflammatory Bowel Disease on Anti-TNF Infusions at an Outpatient Pediatric Infusion Center

Background: Psoriasis is an auto-immune skin condition consisting of proliferation of skin cells that classically presents with erythematous papules with a silvery scale appearance. Both genetic and environmental factors are involved in its pathogenesis. The more common form is psoriasis vulgaris while children can present with guttate psoriasis, a self-limiting form. A 2018 meta-analysis reported significant associations between psoriasis and inflammatory bowel disease (IBD). Certain medications can trigger or exacerbate psoriasis, including anti-TNF agents which are used for treatment of IBD. Anti-TNF drugs are used for psoriasis treatment but can also paradoxically induce or exacerbate psoriasis. There is limited published data on the association of anti-TNF infusions treated IBD with psoriasis in pediatric patients. Methods: By retrospective chart review we identified 195 previously anti-TNF naive pediatric patients with Crohn’s disease (CD) or ulcerative colitis (UC) who received anti-TNF infusions during January 2019 to July 2025. The population was ethnically diverse, with a median age of 13 years at time of their first biologic infusion. Results: Psoriasis was found in 13 patients, including 7 females and 6 males, after the initiation of anti-TNF infusions. The median age at infusion initiation was 10 years. Most (n = 12) had CD however there was no statistically significant difference between CD (12 of 150) and UC (1 of 42). There was no association between sex and psoriasis. Affected areas include the head (n = 8), lower extremities (n = 6), upper extremities (n = 3), axilla (n = 2), neck (n = 1), anterior trunk (n = 1), posterior trunk (n = 1), and generalized (n = 1). Estimated median time from anti-TNF initiation to psoriasis diagnosis was 27 months. Nine continued with anti-TNF infusions. Three patients were transitioned to ustekinumab treatment due to the psoriasis. One patient’s medication was switched for another reason (infusion reaction). Conclusions: Addressing psoriasis is important in IBD patients treated with anti-TNF infusions for both their clinical care and their quality of life. Clinicians should have a high index of suspicion for psoriasis in patients with IBD and with anti-TNF therapy. Limitations of our study include its retrospective/cross-sectional nature, which limits assessment of temporality and causation. Also, psoriasis is an underdiagnosed condition, and patients at a non-dermatology specialty office visit may not routinely report milder manifestations. While psoriasis is more commonly a chronic skin disorder, there is a self-limited form that is seen in children. If this latter form were present in our patients, clinical improvement may not necessarily be related to clinical factors, thus confounding analysis of our observations. Further studies to explore these potential associations and the temporality of the observations are recommended. This information should help patients, caregivers and clinicians to navigate IBD care.