Carter J D, Gerard H C, Hudson A P
Department of Internal Medicine, Division of Rheumatology, University of South Florida School of Medicine, 12901 Bruce B Downs Blvd MDC81, Tampa, Florida 33612, USA.
Ann Rheum Dis. 2008 Aug;67(8):1181-3. doi: 10.1136/ard.2007.082842. Epub 2008 Feb 25.
Rarely, tumour necrosis factor (TNF)alpha antagonist therapy has been associated with de novo psoriasiform eruptions. This is unusual in that these same drugs are used to treat psoriasis. Most of these cases involve the palms and soles, yet palmoplantar pustular psoriasis represents only 1.7% of all cases of psoriasis. Keratoderma blenorrhagicum is a psoriasiform rash that occurs primarily on the palms and soles of some patients with reactive arthritis. It is grossly and histologically indistinguishable from pustular psoriasis. Chlamydia trachomatis is a common aetiological agent for reactive arthritis, and in vitro studies have shown that chlamydial replication is inversely proportional to TNFalpha levels. Three patients taking TNFalpha antagonists are presented who developed such lesions and who were found to be positive for C trachomatis DNA in the affected skin. It is proposed that these psoriasiform lesions may not be psoriasis, but rather keratoderma blenorrhagicum.
肿瘤坏死因子（TNF）α拮抗剂治疗极少与新发银屑病样皮疹相关。这很不寻常，因为这些药物同样用于治疗银屑病。这些病例大多累及手掌和足底，然而掌跖脓疱型银屑病仅占所有银屑病病例的1.7%。脓性角化病是一种银屑病样皮疹，主要发生在一些反应性关节炎患者的手掌和足底。它在外观和组织学上与脓疱型银屑病无法区分。沙眼衣原体是反应性关节炎常见的病原体，体外研究表明衣原体复制与TNFα水平呈反比。本文报告了3例服用TNFα拮抗剂的患者出现此类皮损，且在受累皮肤中检测到沙眼衣原体DNA阳性。有人提出这些银屑病样皮损可能并非银屑病，而是脓性角化病。
