Al-Janabi A, Foulkes A C, Mason K, Smith C H, Griffiths C E M, Warren R B
The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK.
Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
J Eur Acad Dermatol Venereol. 2020 Jul;34(7):1440-1448. doi: 10.1111/jdv.16246. Epub 2020 Feb 27.
The use of biologic therapies for the treatment of chronic plaque psoriasis has been linked to the development of atopic eczema, amongst other cutaneous adverse events. This can cause diagnostic confusion and create difficulty in the management of patients with plaque psoriasis. The main objective of this systematic review was to review all cases of eczema, including atopic eczema, reported in patients treated with biologics for chronic plaque psoriasis. PubMed, Medline and Embase databases were used to identify studies reporting eczema in patients treated with biologic therapy for chronic plaque psoriasis. A total of 92 patients were identified from 24 studies, with patients treated with either: adalimumab; etanercept; infliximab; ixekizumab; secukinumab; or ustekinumab. Factors common to some reported cases include: a prior history of atopy; eosinophilia; raised serum immunoglobulin E. Twenty-three had documented treatment outcomes; 14 had biologic therapy discontinued or switched. Management strategies included topical or oral corticosteroids, and treatment with alternative systemic agents such as ciclosporin or apremilast. This adverse event occurred in 1.0-12.1% of patients within trial data and observational studies. This review demonstrates that there are consistent reports of a switch to an atopic eczema phenotype from psoriasis in patients taking biologics inhibiting tumour necrosis factor alpha and the interleukin (IL)-17/IL-23 axis. The majority stopped the implicated biologic, but conservative management was successful in some cases. Those with an atopic diathesis may be more at risk. Elucidation of mechanisms and risk factors would contribute to optimal therapy selection for individual patients.
生物疗法用于治疗慢性斑块状银屑病与特应性皮炎等其他皮肤不良事件的发生有关。这可能导致诊断混淆，并给斑块状银屑病患者的管理带来困难。本系统评价的主要目的是回顾所有在用生物制剂治疗慢性斑块状银屑病的患者中报告的湿疹病例，包括特应性皮炎。使用PubMed、Medline和Embase数据库来识别报告在用生物疗法治疗慢性斑块状银屑病的患者中出现湿疹的研究。从24项研究中总共识别出92例患者，这些患者接受了以下任一药物治疗：阿达木单抗；依那西普；英夫利昔单抗；司库奇尤单抗；苏金单抗；或乌司奴单抗。一些报告病例的共同因素包括：特应性病史；嗜酸性粒细胞增多；血清免疫球蛋白E升高。23例有记录的治疗结果；14例生物疗法停药或换药。管理策略包括局部或口服皮质类固醇，以及用环孢素或阿普米拉斯等替代全身性药物治疗。在试验数据和观察性研究中，这一不良事件发生在1.0%-12.1%的患者中。本评价表明，在用抑制肿瘤坏死因子α和白细胞介素（IL）-17/IL-23轴的生物制剂治疗的患者中，有一致的报告称银屑病转变为特应性皮炎表型。大多数患者停用了相关生物制剂，但在某些情况下保守治疗是成功的。有特应性素质的患者可能风险更高。阐明机制和危险因素将有助于为个体患者选择最佳治疗方案。
