A case of concurrent inverse psoriasis and Hailey-Hailey disease induced by infliximab therapy for Crohn`s disease = A case of concurrent inverse psoriasis and Hailey-Hailey disease induced by infliximab therapy for Crohn`s disease

다국어 초록 (Multilingual Abstract)

Anti-TNF-α agents are effective treatment for inflammatory bowel disease (IBD). But sometimes it induce psoriasis paradoxically. Recently Guerra et al reported 1.62% of cumulative incidence of induced psoriasis in IBD treated by anti-TNF-α. The half of cases was induced by infliximab and 5% of the cases presented as inverse type of psoriasis. A 15 year old girl was evaluated for her newly developed skin lesion after the eighth infusion of infliximab for treatment of Crohn’s disease (CD). The lesion exhibited its first onset of mildly itching scaly erythematous patches and plaques on both axilla, antecubital fossa, inguinal area and weeping patch on perianal skin. Axillary skin biopsy showed histopathological findings compatible with psoriasis and intraepidermal acantholysis compatible with Hailey-Hailey disease(HHD) in another section. Patient history revealed that her father and some of her relatives had history of having similar symptoms on their axilla. Based on the histopathologic findings and family history along with clinical presentation, paradoxical concomitant induction of inverse psoriasis and Hailey-Hailey disease by infliximab were suspected. The patient’s skin lesions were resolved by withdrawal of infliximab and topical steroid treatment without any further flare-up. Her CD is being well controlled with azathioprine. We hereby report a unique case of concurrent inverse psoriasis and HHD provoked byinfliximab therapy.