TNF inhibitors effective for treating refractory acne but also have potential to induce acne occurrence: JAMA

Tumour necrosis factor–α inhibitors are approved for treating several inflammatory diseases and are sometimes used off-label to treat severe acne forms that are refractory to conventional therapies. However, TNFis use can also be followed by acne occurrence, indicating an association between TNFis and acne. A systematic review of most of the literature comprising case reports and series have not been conducted.

Against the above background, Aaron Gabriel W. Sandoval, Harvard Medical School, Boston, Massachusetts, and colleagues aimed to characterize the clinical presentations, demographic characteristics, treatments, and outcomes of patients receiving TNFis for acne treatment and patients who develop acne after treatment of other conditions with TNFis.

The investigators addressed the question, what is the role of tumour necrosis factor–α inhibitors in treating and inducing acne?

For this purpose, the investigators performed a systematic literature review and reported per the PRISMA guidelines. Online databases were searched from inception through October 17, 2022. They included studies reported on patients of any age or sex who received TNFis whose treatment was followed by the occurrence or resolution of acne.

The review included 53 studies comprising 64 patients who received TNFis for acne treatment (n=47) or experienced acne following treatment with TNFis for a different condition (n = 17). The TNFis used included infliximab, adalimumab, and etanercept.

The authors reported the following findings:

• Most of the 47 patients treated for acne with TNFis had previously received antibiotics (66.0%) or isotretinoin (68.1%).
• Most (93.6%) experienced partial improvement (53.2%) or clearance (40.4%), with very few adverse effects reported (6.4%).
• Acne manifested as part of an inflammatory syndrome for 63.8% of patients.
• Among the 17 patients treated TNFis for a different condition followed by acne, only one patient (5.9%) reported a history of acne.
• Therapy with TNFis was either discontinued (47.1%) or altered (35.3%) in most patients due to acne occurrence, typically with improvement in symptoms.

"The results of the systematic review indicate that TNFis can be effective for refractory acne treatment but can also be linked with acme occurrence in certain conditions," the researchers wrote.

"Further studies elucidating TNF's role in inducing and treating acne could yield insight into off-label TNFi use and acne pathogenesis, potentially guiding the clinical care of acne patients treated or induced by TNFis," they conclude.

Reference:

Sandoval AGW, Vaughn LT, Huang JT, Barbieri JS. Role of Tumor Necrosis Factor–α Inhibitors in the Treatment and Occurrence of Acne: A Systematic Review. JAMA Dermatol. Published online March 17, 2023. doi:10.1001/jamadermatol.2023.0269