Laga Alvaro C, Vleugels Ruth A, Qureshi Abrar A, Velazquez Elsa F
Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Am J Dermatopathol. 2010 Aug;32(6):568-73. doi: 10.1097/DAD.0b013e3181cb3ff7.
Tumor necrosis factor (TNF)-α inhibitors (anti-TNF-α biologic drugs), currently used to treat different autoimmune conditions, may be associated with cutaneous drug reactions. New onset or worsening of psoriasis and psoriasis-like reactions have been reported in these patients. However, not much is known about the different histopathologic patterns of such skin lesions. The aim of this study was to evaluate the pathologic spectrum of clinically papulosquamous to pustular "psoriasiform" lesions in this setting. Sixteen biopsies from 9 patients on anti-TNF-α therapy for rheumatoid arthritis (n = 7), Crohn disease (n = 1), and Behçet disease (n = 1) who developed a "psoriasiform" skin rash during treatment were included in this study. None of the patients had history of psoriasis. Five patients (10 biopsies) showed a psoriasis-like pattern that varied from that seen in guttate lesions (4 biopsies), to well-established plaques (3 biopsies) to pustular psoriasis (3 biopsies). Three patients (4 biopsies) showed an interface/lichenoid dermatitis mimicking lichen planus. Two patients (2 biopsies) showed features of pustular folliculitis. Eosinophils varied from none (2 biopsies) to scattered (7 biopsies) to numerous (7 biopsies). Plasma cells were present in most cases. All pustular lesions had negative cultures. In conclusion, anti-TNF drugs elicit a spectrum of cutaneous reactions that go beyond the classical eosinophilic-rich hypersensitivity reaction and may closely mimic primary dermatitis. In addition to psoriasis-like lesions, lichen planus-like dermatitis and sterile pustular folliculitis should be included in the list of anti-TNF-α-related drug reactions. Because the different histopathologic findings may be subtle, clinical correlation is crucial to make the diagnosis.
肿瘤坏死因子（TNF）-α抑制剂（抗TNF-α生物药物）目前用于治疗不同的自身免疫性疾病，可能与皮肤药物反应有关。已有报道称这些患者出现新发或加重的银屑病及银屑病样反应。然而，对于此类皮肤病变的不同组织病理学模式了解甚少。本研究的目的是评估在这种情况下临床从丘疹鳞屑性到脓疱性“银屑病样”病变的病理谱。本研究纳入了9例接受抗TNF-α治疗的患者的16份活检标本，这些患者分别患有类风湿关节炎（n = 7）、克罗恩病（n = 1）和白塞病（n = 1），在治疗期间出现了“银屑病样”皮疹。所有患者均无银屑病病史。5例患者（10份活检标本）表现出银屑病样模式，从点滴状皮损（4份活检标本）、典型斑块状（3份活检标本）到脓疱型银屑病（3份活检标本）不等。3例患者（4份活检标本）表现为类似扁平苔藓的界面/苔藓样皮炎。2例患者（2份活检标本）表现为脓疱性毛囊炎特征。嗜酸性粒细胞数量从无（2份活检标本）到散在（7份活检标本）再到大量（7份活检标本）不等。大多数病例中存在浆细胞。所有脓疱性病变培养结果均为阴性。总之，抗TNF药物引发的皮肤反应谱超出了经典的富含嗜酸性粒细胞的超敏反应，可能与原发性皮炎极为相似。除了银屑病样病变外，扁平苔藓样皮炎和无菌性脓疱性毛囊炎也应列入抗TNF-α相关药物反应清单。由于不同的组织病理学表现可能不明显，临床关联对于做出诊断至关重要。
