Mälkönen Tarja, Wikström Anne, Heiskanen Kaarina, Merras-Salmio Laura, Mustonen Harri, Sipponen Taina, Kolho Kaija-Leena
*Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland; †Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland; ‡Department of Surgery, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland; and §Department of Medicine, Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland.
Inflamm Bowel Dis. 2014 Aug;20(8):1309-15. doi: 10.1097/MIB.0000000000000088.
Although the development of therapy-related skin reactions is common along with an increase in the number of adult patients receiving anti-TNFα, there are few studies on pediatric inflammatory bowel disease; hence, this prospective study focuses on skin reactions related to infliximab therapy.
All pediatric patients with inflammatory bowel disease undergoing infliximab therapy were prospectively screened for the presence of skin manifestations at the time of each infusion between March 1, 2011 and March 31, 2011 at Children's Hospital, Helsinki, Finland. Blood inflammatory markers and fecal calprotectin levels were measured at the time of infusions.
During the study period, 84 children with inflammatory bowel disease (Crohn's n = 64) received infliximab infusions (the median duration of therapy 12.2 mo). Almost every other patient (n = 40; 47.6%) presented chronic skin reactions, 23% with lesions considered severe. Most commonly, the patient's ear lobes and scalp were affected with psoriasis-like manifestations, followed by their eyelids, perioral and pubic area, trunk, and the extremities. However, an HLA-Cw*0602 genotype associating with psoriasis was rare. Interestingly, most patients with skin reactions had a low degree of intestinal inflammation based on their fecal calprotectin levels (median level, 133 μg/g versus 589 in unaffected patients; P < 0.016). Seven patients (8.3% of all patients but 17% of those with skin lesions) discontinued the given therapy due to a skin reaction.
Skin reactions are common during maintenance therapy with infliximab in pediatric patients. For most patients, skin reactions seem to correlate with a low level of intestinal inflammation. Although potentially harsh, skin lesions mostly allow continuation of infliximab.
尽管随着接受抗TNFα治疗的成年患者数量增加，治疗相关皮肤反应的发生很常见，但关于儿童炎症性肠病的研究却很少；因此，这项前瞻性研究聚焦于英夫利昔单抗治疗相关的皮肤反应。
2011年3月1日至2011年3月31日期间，在芬兰赫尔辛基儿童医院，对所有接受英夫利昔单抗治疗的儿童炎症性肠病患者在每次输注时进行前瞻性筛查，以确定是否存在皮肤表现。在输注时测量血液炎症标志物和粪便钙卫蛋白水平。
在研究期间，84例炎症性肠病患儿（克罗恩病n = 64）接受了英夫利昔单抗输注（治疗的中位持续时间为12.2个月）。几乎每隔一位患者（n = 40；47.6%）就出现慢性皮肤反应，其中23%的患者病变被认为严重。最常见的是，患者的耳垂和头皮出现银屑病样表现，其次是眼睑、口周和耻骨区、躯干及四肢。然而，与银屑病相关的HLA - Cw*0602基因型很少见。有趣的是，根据粪便钙卫蛋白水平，大多数有皮肤反应的患者肠道炎症程度较低（中位水平为133μg/g，而未受影响患者为589μg/g；P < ０.016）。7例患者（占所有患者的8.3%，但占皮肤病变患者的17%）因皮肤反应而停止既定治疗。
在儿童患者中，英夫利昔单抗维持治疗期间皮肤反应很常见。对大多数患者而言，皮肤反应似乎与肠道炎症程度低相关。尽管皮肤病变可能很严重，但大多情况下可继续使用英夫利昔单抗。
