Tadiotto Cicogna Giulia, Messina Francesco, Nalotto Linda, Szekely Serena, Alaibac Mauro
Unit of Dermatology, Department of Medicine, University of Padua, Padova, 35121, Italy.
Unit of Reumathology, Department of Medicine, University of Padua, Padova, 35121, Italy.
F1000Res. 2019 Mar 26;8:336. doi: 10.12688/f1000research.18493.1. eCollection 2019.
Psoriasis is a chronic immune-mediated inflammatory disease. Up to 40% of patients with psoriasis may develop psoriatic arthritis. Currently, interleukin (IL)-17/IL-23 pathways are identified as key factors in the immunopathogenesis of both conditions. Here we describe the case of a patient who developed psoriasiform skin lesions 10 months after the initiation of anti-IL17 therapy for psoriatic arthritis. The underlying disease had responded well to the therapy, but the patient developed a striking pustular eruption at the fingers with nail involvement, onycholysis, yellow discoloration, and subungual keratosis. Clinical and histological findings were consistent with an acrodermatitis continua of Hallopeau-like eruption. Skin lesions subsided after discontinuation of the responsible anti-IL17 agent. The interpretation of this paradoxical side effect of biological therapies remains unclear but may relate to an unbalanced inflammatory cytokine response induced by the inhibition of TNF activity. It is likely that patients, who are genetically prone, may respond exaggeratedly to a cytokine imbalance. The identification of this kind of patient, in the future, could be useful in order to choose the correct therapy.
银屑病是一种慢性免疫介导的炎症性疾病。高达40%的银屑病患者可能会发展为银屑病关节炎。目前，白细胞介素（IL）-17/IL-23通路被确定为这两种疾病免疫发病机制中的关键因素。在此，我们描述了一例患者，该患者在开始接受抗IL-17治疗银屑病关节炎10个月后出现了银屑病样皮肤病变。基础疾病对该治疗反应良好，但患者手指出现了明显的脓疱性皮疹，并累及指甲，出现甲剥离、发黄及甲下角化过度。临床和组织学表现与类似Hallopeau连续性肢端皮炎的皮疹相符。停用相关抗IL-17药物后，皮肤病变消退。生物疗法这种矛盾的副作用的解释仍不明确，但可能与抑制TNF活性诱导的炎症细胞因子反应失衡有关。遗传易感性高的患者可能对细胞因子失衡反应过度。未来识别这类患者可能有助于选择正确的治疗方法。
