Anti-tumor necrosis factor-alpha (TNF-alpha) drug trials in pSS have failed to show promising results; although a potential protective role for TNF-alfa against lymphoproliferation has been hypothesized, it has been demonstrated that depletion of TNF-alpha may increase BAFF (B-cell activating factor) levels in humans, discouraging its use for pSS in clinical practice [68]. This evidence concerns the gene TNF and peeling skin syndrome.