TNF-Ձ antagonists have been successfully utilized in the treatment of autoimmune diseases, including psoriasis and psoriatic arthritis. Paradoxically, new onset or exacerbation of psoriatic lesions during treatment with TNF-Ձ antagonists have been reported. It has been postulated that TNF-Ձ blockade may cause disruption in the balance between TNF-Ձ and type 1 interferon (IFN)-Ձ, which are the key players in the pathogenesis of psoriasis. We report a case of psoriasis exacerbation during TNF-Ձ antagonist therapy in a 53-years-old man with ankylosing spondylitis. The patient has been treated with etanercept for 3 years and 7 months when he developed accelerated deterioration of psoriasis. His condition was previously under control solely by local treatment. Physical examination revealed vigorous desquamative lesions with silvery scale in both lower legs. Deterioration of psoriasis was attributed to etanercept therapy and was subsequently discontinued. Clinical improvement of psoriasis has been observed 2 months following cessation of etanercept.

Keywords: Psoriasis, TNF-Ձ, antagonists, Ankylosing spondylitis