Consolidated Pathology Consultants, Libertyville, Illinois, USA.
Department of Dermatology, Northwestern Medicine Regional Medical Group, Naperville, Illinois, USA.
J Cutan Pathol. 2021 Jun;48(6):771-774. doi: 10.1111/cup.13952. Epub 2021 Jan 12.
Drug-induced psoriasiform alopecia is an increasingly recognized form of alopecia mostly reported in association with TNF-alpha inhibitors. However, drug-induced psoriasiform alopecia in association with IL-17A inhibitors has not been described. We present a 62-year-old woman with severe psoriasis who developed new psoriatic plaques on the scalp with alopecia after initiating ixekizumab (anti-IL-17A). Scalp biopsy specimens revealed a non-cicatricial alopecia with increased telogen/catagen follicles, atrophy of the sebaceous glands, peribulbar and perifollicular inflammation with frequent lymphocytes, plasma cells, eosinophils, psoriasiform dermatitis, and lack of intra-corneal or intra-epidermal neutrophils. Overall, the clinical and histopathologic findings were most compatible with a drug-induced psoriasiform alopecia in association with IL-17A inhibitor therapy. Our case shows that drug-induced psoriasiform alopecia can paradoxically occur in patients on IL-17A inhibitor therapy and contributes to the growing list of cutaneous eruptions associated with biologic agents.
药物诱导的银屑病样脱发是一种越来越被认识到的脱发形式，主要与 TNF-α 抑制剂相关报道。然而，与 IL-17A 抑制剂相关的药物诱导的银屑病样脱发尚未被描述。我们报告了一例 62 岁女性，患有严重银屑病，在开始使用依奇珠单抗（抗 IL-17A）后，头皮出现新的银屑病斑块和脱发。头皮活检显示非瘢痕性脱发，生长期/退行期毛囊增加，皮脂腺萎缩，眶周和毛囊周围炎症频繁出现淋巴细胞、浆细胞、嗜酸性粒细胞，银屑病样皮炎，以及缺乏角膜内或表皮内中性粒细胞。总的来说，临床和组织病理学发现最符合与 IL-17A 抑制剂治疗相关的药物诱导的银屑病样脱发。我们的病例表明，药物诱导的银屑病样脱发可在接受 IL-17A 抑制剂治疗的患者中出现矛盾，并且是与生物制剂相关的越来越多的皮肤发疹之一。
