Alexis Andrew F, Strober Bruce E
Department of Dermatology, St. Luke's-Roosevelt Hospital Center, New York, NY, USA.
J Cutan Med Surg. 2005 Dec;9(6):296-302. doi: 10.1007/s10227-005-0110-7.
Tumor necrosis factor-alpha (TNF-a) is a proinflammatory cytokine that plays an immunomodulatory role in a variety of systemic and dermatologic diseases. Currently, three anti-TNF-a drugs are available in North America- infliximab (approved in the U.S. for the treatment of rheumatoid arthritis, Crohn's disease, ankylosing spondylitis, ulcerative colitis, and psoriatic arthritis), etanercept (approved in the U.S. for the treatment of rheumatoid arthritis, juvenile rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and psoriasis), and adalimumab (approved for the treatment of rheumatoid arthritis and psoriatic arthritis).
To review the current literature supporting alternative (and currently off-label) dermatologic uses of TNF-a antagonists.
A MEDLINE search (1966-March 2005) was conducted using the keywords "infliximab," "etanercept," "adalimumab," "TNF inhibitors," and "off-label" to identify published reports of off-label dermatologic uses of TNF-a inhibitors.
Anti-TNF-a therapies have been reported in the following dermatologic diseases: sarcoidosis, hidradenitis suppuritiva, cicatricial pemphigoid, Behçet's disease, pyoderma gangrenosum, multicentric reticulohistiocytosis, apthous stomatitis, Sneddon-Wilkinson disease, SAPHO syndrome, pityriasis rubra pilaris, eosinophilic fasciitis, panniculitis, Crohn's disease, necrobiosis lipoidica diabeticorum, dermatomyositis, and scleroderma. The vast majority of these reports are in the form of individual case reports and small case series. Only two published randomized controlled trials involving the off-label use of a TNF inhibitor were found.
A growing number of published reports suggest that anti-TNF-a therapies may be effective in the treatment of numerous inflammatory skin diseases outside their currently approved indications.
肿瘤坏死因子-α（TNF-α）是一种促炎细胞因子，在多种全身性疾病和皮肤病中发挥免疫调节作用。目前，北美有三种抗TNF-α药物——英夫利昔单抗（在美国被批准用于治疗类风湿性关节炎、克罗恩病、强直性脊柱炎、溃疡性结肠炎和银屑病关节炎）、依那西普（在美国被批准用于治疗类风湿性关节炎、青少年类风湿性关节炎、银屑病关节炎、强直性脊柱炎和银屑病）和阿达木单抗（被批准用于治疗类风湿性关节炎和银屑病关节炎）。
综述支持TNF-α拮抗剂在皮肤科替代（目前为非适应证）应用的现有文献。
利用关键词“英夫利昔单抗”“依那西普”“阿达木单抗”“TNF抑制剂”和“非适应证”进行医学文献数据库（MEDLINE）检索（1966年至2005年3月），以识别已发表的关于TNF-α抑制剂非适应证皮肤科应用的报告。
抗TNF-α疗法已在以下皮肤病中得到报道：结节病、化脓性汗腺炎、瘢痕性类天疱疮、白塞病、坏疽性脓皮病、多中心网状组织细胞增生症、复发性阿弗他口炎、Sneddon-Wilkinson病、滑膜炎、痤疮、脓疱病、骨肥厚、增殖性皮炎、红皮病型银屑病、嗜酸性筋膜炎、脂膜炎、克罗恩病、糖尿病性类脂质渐进性坏死、皮肌炎和硬皮病。这些报告绝大多数为个案报告和小病例系列形式。仅发现两项已发表的涉及TNF抑制剂非适应证应用的随机对照试验。
越来越多已发表的报告表明，抗TNF-α疗法可能对治疗目前批准适应证以外的多种炎症性皮肤病有效。
