Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan.
J Dermatol. 2018 Jun;45(6):732-734. doi: 10.1111/1346-8138.14295. Epub 2018 Mar 22.
Psoriasis is a chronic inflammatory skin disease mainly mediated by a T-helper cell subset, Th17 cells. Recently, increased levels of total serum immunoglobulin (Ig)E have been reported in a subset of psoriatic patients. Ustekinumab (UST) is one of the most commonly used biologic agents for the treatment of moderate to severe plaque psoriasis, and a previous report also documented effectiveness of UST for psoriatic patients with high serum IgE levels. We experienced two psoriatic patients with high serum IgE levels, in whom UST completely improved psoriasis but paradoxically provoked or exacerbated atopic dermatitis (AD)-like symptoms. This reciprocal phenomenon suggests the shift of Th balance toward Th2, along with altered profiles of inflammatory cytokines. It appears prudent to consider the possibility of such adverse effects when treating psoriatic patients with UST with concomitant AD symptoms, a history of AD or high serum IgE levels.
银屑病是一种慢性炎症性皮肤病，主要由辅助性 T 细胞亚群 Th17 细胞介导。最近，有报道称在一部分银屑病患者中总血清免疫球蛋白 (Ig)E 水平升高。乌司奴单抗（UST）是治疗中重度斑块状银屑病最常用的生物制剂之一，先前的报告也证明了 UST 对高血清 IgE 水平的银屑病患者有效。我们治疗了两名高血清 IgE 水平的银屑病患者，乌司奴单抗完全改善了银屑病，但却反常地引发或加重了特应性皮炎 (AD)样症状。这种相反的现象提示 Th 平衡向 Th2 倾斜，同时炎症细胞因子的特征也发生了改变。因此，在治疗伴有 AD 症状、AD 病史或高血清 IgE 水平的银屑病患者时，需要考虑到这种不良反应的可能性。
