Dermatology Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain.
J Dermatol. 2019 Sep;46(9):798-801. doi: 10.1111/1346-8138.15012. Epub 2019 Jul 20.
Psoriasis is a multifactorial systemic disease with predominantly cutaneous manifestations. The role of tuberculosis infection in the pathogenesis of psoriasis has not been consistently proven. Current guidelines recommend screening for tuberculosis infection in any patient with psoriasis when the initiation of biologic therapy is being considered. Isoniazid is an antibiotic with high bactericidal effect on replicating mycobacteria and constitutes the most commonly prescribed treatment for latent tuberculosis infection. Here, we report two cases of patients with psoriasis who presented at our clinic with extensive cutaneous involvement despite previous treatments with topical and systemic therapies. Both were considered as candidates for biologic therapy. As part of the screening protocol, a tuberculin test was performed with a positive result. In the absence of symptoms and chest radiography findings, isoniazid 300 mg/day for 6 months was prescribed to treat latent tuberculosis infection. This resulted in significant clearing of their skin lesions in the absence of any other concurrent treatment, apart from emollients. Both patients remained clinically stable and with no need of further systemic treatment. This situation has only been described twice before in the English-language published work. These cases highlight the possible role of tuberculosis infection in the pathogenesis of psoriasis, suggesting the possible existence of a link between untreated infection and skin lesions. This can lead to consideration of novel therapeutic strategies and new lines of investigation.
银屑病是一种多因素的系统性疾病，主要表现为皮肤症状。结核病感染在银屑病发病机制中的作用尚未得到一致证实。目前的指南建议，在考虑开始生物治疗时，应对任何患有银屑病的患者进行结核病感染筛查。异烟肼是一种对复制分枝杆菌具有高杀菌作用的抗生素，是治疗潜伏性结核病感染最常用的药物。在这里，我们报告了两例银屑病患者的病例，他们在我们的诊所就诊时，尽管之前接受了局部和全身治疗，但仍有广泛的皮肤受累。两人都被认为是生物治疗的候选者。作为筛查方案的一部分，进行了结核菌素试验，结果呈阳性。在没有症状和胸部 X 线检查结果的情况下，开处了异烟肼 300mg/天，疗程 6 个月，以治疗潜伏性结核病感染。除了保湿剂外，他们的皮肤病变在没有任何其他同时进行的治疗的情况下显著消退。两名患者均保持临床稳定，无需进一步的全身治疗。这种情况在英文文献中仅被描述过两次。这些病例突出了结核病感染在银屑病发病机制中的可能作用，表明未治疗的感染与皮肤病变之间可能存在联系。这可能导致考虑新的治疗策略和新的研究方向。
