Department of Dermatology, University of California Irvine Health, Irvine, CA, USA.
Department of Internal Medicine, MacNeal Hospital, Berwyn, IL, USA.
J Eur Acad Dermatol Venereol. 2015 Nov;29(11):2104-11. doi: 10.1111/jdv.13246. Epub 2015 Aug 26.
Sarcoidosis is a systemic granulomatous disease that affects numerous organs, commonly manifesting at the lungs and skin. While corticosteroids remain the first line of treatment, tumour necrosis factor alpha (TNF-α) inhibitors have been investigated as one potential steroid sparing treatment for sarcoidosis. TNF-α is one of many components involved in the formation of granulomas in sarcoidosis. While there have been larger scale studies of biologic TNF-α inhibition in systemic sarcoidosis, studies in cutaneous disease are limited. Paradoxically, in some patients treated with biologic TNF-α inhibitors for other diseases, treatment can induce the development of sarcoidosis. In the light of this complexity, we discuss the role of TNF-α in granuloma formation, the therapeutic role of TNF-α inhibition and immunologic abnormalities following treatment with these TNF-α inhibitors including drug-specific alterations involving interferon-γ, lymphotoxin-α, TNF receptor 2 (TNFR2) and T-regulatory cells.
结节病是一种全身性肉芽肿性疾病，可影响多个器官，常见于肺部和皮肤。虽然皮质类固醇仍然是治疗的首选，但肿瘤坏死因子-α（TNF-α）抑制剂已被研究作为结节病的一种潜在的类固醇节约治疗方法。TNF-α 是结节病肉芽肿形成中涉及的众多成分之一。虽然已经有更大规模的研究表明生物 TNF-α 抑制对系统性结节病有效，但对皮肤疾病的研究有限。矛盾的是，在一些因其他疾病而接受生物 TNF-α 抑制剂治疗的患者中，治疗可能会诱发结节病的发生。鉴于这种复杂性，我们讨论了 TNF-α 在肉芽肿形成中的作用，TNF-α 抑制的治疗作用以及使用这些 TNF-α 抑制剂治疗后的免疫异常，包括涉及干扰素-γ、淋巴毒素-α、TNF 受体 2（TNFR2）和 T 调节细胞的药物特异性改变。
