Characterization of TNF‐Alpha Inhibitor Induced Paradoxical Psoriasiform Dermatitis at a Single Center via Retrospective Chart Review

Tumor necrosis factor‐alpha inhibitors (TNFi) are used to treat various autoimmune diseases but can induce paradoxical psoriasiform dermatitis (PD) in a subset of patients. This retrospective chart review aimed to identify risk factors impacting PD severity in 70 pediatric patients at a single center. Forty patients (57.1%) discontinued their initial TNFi: 12/40 (30.0%) switched to another TNFi, with 4/12 (33.3%) experiencing PD recurrence, while 25/40 (62.5%) switched medication classes. Female sex was associated with increased use of high‐potency topical steroids ( p = 0.01), suggesting more severe disease. Juvenile idiopathic arthritis ( p = 0.02), older age ( p < 0.01), and concomitant immunomodulator use ( p = 0.04) were associated with a longer latency period before PD development.