抗TNF-α抗体製剤に起因する皮膚病変

Skin Lesions Induced by Anti-TNF-α Agents in Patients with Inflammatory Bowel Disease

要旨●当院で2009年1月〜2015年10月までの間に抗TNF-α抗体製剤で治療した炎症性腸疾患患者1,189例（Crohn病853例，潰瘍性大腸炎336例）を対象として皮膚有害事象の発生について検討した．明らかな皮膚病変は49例（4.1％）で確認され，瘙痒症など皮膚症状のみの症例も加えた有害事象の頻度は17.0％と比較的高率であった．皮膚病変では，湿疹・発疹が最も多く，紅斑・膿皮症・皮脂欠乏性皮膚炎･帯状疱疹などがこれに次ぎ，逆説的副反応と呼ばれる乾癬様皮疹の出現（掌蹠膿疱症含め）は6例（0.5％）と海外に比べて低率であった．皮膚病変の出現による抗体製剤治療の中止率は1.4％で，皮膚病変出現例の約50％は軟膏などの局所療法の併用で抗体製剤治療を継続しえていた．

　We examined the incidence of dermatologic adverse effects in 1,189 patients with inflammatory bowel disease（Crohn's disease, n＝853 ; ulcerative colitis, n＝336）treated with anti-TNF-α antibody preparations at our hospital between January 2009 and October 2015. Marked skin lesions were observed in 49 patients（4.1%）. The incidence of adverse effects, including patients with exclusively cutaneous symptoms such as itchiness, was relatively high at 17.0%. Eczema and rash were the most commonly observed skin lesions, followed by erythema, pyoderma, asteatotic dermatitis, and herpes zoster. Psoriasis-like eruptions, a so-called paradoxical side effect, were observed in 6 patients（0.5%）, a lower rate than that reported in previous overseas studies. The rate of antibody treatment discontinuation due to skin lesions was 1.4%, with approximately 50% of patients who developed skin lesions able to continue antibody treatment with the combined use of local therapy such as ointments.