Pediatric Dermatology Study Links JIA,Age & Immunomodulators to Delayed Onset of Psoriasis in Young TNF-Inhibitor Users
CINCINNATI,OH – A new retrospective study published in Pediatric Dermatology reveals potential predictors for the growth of psoriasis (PD) in children and adolescents undergoing treatment with Tumor Necrosis Factor inhibitors (TNFi) – a common therapy for inflammatory conditions like Crohn’s disease and juvenile idiopathic arthritis (JIA). Researchers at Cincinnati Children’s Hospital Medical Center found that a diagnosis of JIA, older age at the start of TNFi therapy, and concurrent use of immunomodulating drugs are associated with a later onset of PD.
The study, led by Muayad M.Shahin of the University of Cincinnati College of Medicine, analyzed the medical records of 3,418 pediatric patients receiving tnfi therapy between January 2018 and January 2023.The findings offer crucial insights into a known, but often challenging, side effect of these powerful medications.
Understanding TNF-Inhibitors and Psoriasis
TNFi medications – including infliximab and adalimumab – are a cornerstone of treatment for a range of autoimmune and inflammatory diseases affecting children, including Crohn’s disease, JIA, and ulcerative colitis. these drugs work by blocking TNF, a protein that plays a key role in inflammation. However, a paradoxical reaction can occur, where TNFi therapy triggers or exacerbates psoriasis, a chronic skin condition characterized by red, scaly patches.
The Cincinnati children’s study found that 70 patients (2%) developed PD during the study period. The median age at the start of TNFi treatment was 11.7 years, with PD manifesting a median of 16.9 months later. The majority of those affected were female (52.9%) and White (91.4%). Notably, 94% of patients experienced PD at multiple sites on the body.
Key Findings & Treatment Approaches
The research highlighted several important observations:
Resolution Rates: PD rashes resolved in approximately 45.7% of patients, with a median time to resolution of 15.5 months.
Crohn’s Disease Predominance: The majority (71.4%) of patients who developed PD also had Crohn’s disease. Infliximab (52.7%) and adalimumab (44.6%) were the moast commonly used TNFi medications in this group. Treatment Strategies: Treatment for PD primarily involved topical steroids (85.7%), with a notable proportion also receiving systemic medications (15.4%) and non-steroidal topical treatments like tacrolimus, pimecrolimus, and calcipotriene (24.3%).
Treatment Discontinuation: Over half of the patients (57.1%) had their initial TNFi discontinued due to PD. Of those, approximately 30% switched to another TNFi (with a 33% recurrence rate of PD), while 62.5% switched to a different medication class, though PD persisted in 36% of those patients.
Gender & Treatment: Girls were more likely to be prescribed high-potency topical steroids, potentially reflecting differences in disease severity or prescribing patterns.
Predictive Factors: Statistical analysis revealed that a JIA diagnosis was associated with a delayed PD onset (22.6 months later, P = .02). Concomitant immunomodulator use also correlated with later onset (11.0 months later, P = .04), as did starting TNFi therapy at an older age (2.4 months later per year of age, P < .01).
Future Research Needed
the authors acknowledge the study’s limitations, including its retrospective design which limited detailed descriptions of the skin eruptions and inconsistencies in defining “severe” PD. They emphasize the need for further research to better understand the factors influencing PD severity in pediatric patients. Specifically,they note the need to clarify whether female sex truly influences severity,as current findings are conflicting.
This research was funded by the National Institute of Arthritis and Musculoskeletal and skin Diseases Core Center and the University of Cincinnati Office of Research. One author disclosed a consulting relationship with LEO Pharma.
Source: shahin, M.M., et al. (2025). Published online July 31,2025,in Pediatric Dermatology. https://onlinelibrary.wiley.com/doi/10.1111/pde.16039
