治疗多种炎症疾病的肿瘤坏死因子-α 抑制剂（TNFi）有时会被非指定地用于治疗难治性痤疮。然而，使用TNFi也可能引起痤疮的发生，表明TNFi与痤疮存在关联。该领域的大部分文献由个案报告和一系列文章组成，尚未系统评审。为了确定接受TNFi治疗痤疮和在接受TNFi治疗其他疾病后出现痤疮的患者的人口统计学特征、临床表现、治疗和预后。进行了系统的文献综述，并按照推荐报告系统综述和Meta分析报告准则报告。搜索了PubMed和Web of Science，时间跨度从创刊到2022年10月17日。所包含的研究报告了任何性别或年龄患者接受TNFi治疗之后的痤疮解决或发生。两个独立的审阅人员按预先确定的标准筛选研究，并从每个研究中提取数据，这些数据进行了数量化合并。共收录了53项研究，涉及64名患者接受 TNFi治疗痤疮（n=47）或在接受TNFi治疗其他疾病后出现痤疮（n=17），平均年龄为28.7岁，范围为12-64岁，女性个体6人（8.8%）。使用的TNFi包括阿达木单抗、英夫利昔单抗和英夫周普单抗。在接受针对痤疮的TNFi治疗的47名患者中，大多数已先前接受过抗生素（31人[66.0%]）或异维A酸（32人[68.1%]）治疗。大部分患者（44人[93.6%]）出现了部分改善（25人[53.2%]）或清除（19人[40.4%]），仅有极少数报告出现副作用（3人[6.4%]）。痤疮作为63.8％患者的炎症综合征的一部分表现出来。在接受TNFi治疗其他疾病后出现痤疮的17名患者中，仅有1名患者（5.9％）报告有痤疮史。大部分患者因出现痤疮而中止或改变了TNFi治疗（8人[47.1%]或6人[35.3%]），症状通常会有所改善。这项系统综述的结果表明，TNFi在治疗难治性痤疮方面具有疗效，但在某些情况下也与痤疮的发生相关。进一步的研究阐明TNF在治疗和诱发痤疮中的作用，可能指导接受TNFi治疗痤疮的患者的临床护理。

Tumor necrosis factor-α inhibitors (TNFis) approved to treat several inflammatory diseases are sometimes used off label to treat severe forms of acne that are refractory to conventional therapies. However, use of TNFis can also be followed by acne occurrence, suggesting an association between TNFis and acne. Most of the literature on the topic comprises case reports and series that have not been reviewed in a systematic manner.To characterize the demographic characteristics, clinical presentations, treatments, and outcomes of patients receiving TNFis to treat acne and patients who develop acne following treatment of other conditions with TNFis.A systematic literature review was performed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. PubMed and Web of Science were searched from inception through October 17, 2022. Included studies reported on patients of any sex or age who received TNFis whose treatment was followed by resolution or occurrence of acne. Two independent reviewers screened studies based on predefined criteria and extracted data from each study, which were quantitatively combined.A total of 53 studies reporting on 64 patients who received TNFis for the treatment of acne (n = 47) or who experienced acne after treatment with TNFis for a different condition (n = 17) (mean age, 28.7 years; range, 12-64 years; 6 female individuals [8.8%]) were included. The TNFis used included adalimumab, infliximab, and etanercept. Among the 47 patients treated for acne with TNFis, most had previously received antibiotics (31 [66.0%]) or isotretinoin (32 [68.1%]). Most (44 [93.6%]) experienced partial improvement (25 [53.2%]) or clearance (19 [40.4%]) with very few adverse effects reported (3 [6.4%]). Acne manifested as part of an inflammatory syndrome for 30 patients (63.8%). Among the 17 patients treated TNFis for a different condition followed by the occurrence of acne, only 1 patient (5.9%) reported having a history of acne. Therapy with TNFis was either discontinued (8 [47.1%]) or altered (6 [35.3%]) in most patients due to acne occurrence, typically with improvement in symptoms.The results of this systematic review suggest that TNFis can be effective in treating refractory acne but can also be associated with the occurrence of acne in certain instances. Further studies elucidating the role that TNF plays in treating and inducing acne could yield insight into off-label TNFi use and acne pathogenesis, potentially guiding clinical care of patients with acne treated or induced by TNFis.