TNF inhibitors have been associated with reactivation of hepatitis B.

First-line treatment for patients with psoriasis and hepatitis B is topical agents, phototherapy, ustekinumab, secukinumab, and ixekizumab. TNF inhibitors are considered second-line therapy. Avoid methotrexate and acitretin.

Screen patients with psoriasis for hepatitis B prior to TNF inhibitor therapy by analysis of the triple serology: HBsAg, HBsAb, and HBcAb.