Navarro R, Daudén E
Departamento de Dermatología, Hospital Universitario La Princesa, Madrid, España.
Departamento de Dermatología, Hospital Universitario La Princesa, Madrid, España.
Actas Dermosifiliogr. 2014 Oct;105(8):752-61. doi: 10.1016/j.ad.2013.05.007. Epub 2013 Aug 9.
There have been reports of paradoxical induction or worsening of psoriasis during treatment with tumor necrosis factor (TNF) α agents (infliximab, etanercept, adalimumab, and certolizumab). It has been hypothesized that an imbalance between TNF-α and interferon α might have a role in the etiology and pathogenesis of these reactions. Paradoxical psoriasiform reactions can be divided clinically into de novo psoriasis and exacerbation of preexisting psoriasis. The first, which is more common and more extensively described in the literature, occurs in patients without a history of psoriasis who are receiving TNF-α therapy for another inflammatory disorder. The second can occur with or without changes in the morphology of the lesions. In this article, we review the literature on the clinical and histologic features of paradoxical psoriasiform reactions, analyze their clinical course and treatment, and propose a clinical management model for use in routine practice.
有报道称，在使用肿瘤坏死因子（TNF）α制剂（英夫利昔单抗、依那西普、阿达木单抗和赛妥珠单抗）治疗期间，银屑病会出现矛盾性诱导或病情恶化。据推测，TNF-α与干扰素α之间的失衡可能在这些反应的病因和发病机制中起作用。矛盾性银屑病样反应在临床上可分为新发银屑病和原有银屑病的加重。前者更常见，文献中也有更广泛的描述，发生在没有银屑病病史、因另一种炎症性疾病接受TNF-α治疗的患者中。后者无论皮损形态有无变化均可发生。在本文中，我们回顾了关于矛盾性银屑病样反应的临床和组织学特征的文献，分析了它们的临床病程和治疗方法，并提出了一种用于常规实践的临床管理模式。
