Rosenwasser Natalie, Lee Dale, Sidbury Robert, Zhao Yongdong
Pediatric Rheumatology, Seattle Children's Hospital, University of Washington, MA 7.110, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
Pediatric gastroenterology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
Paediatr Drugs. 2021 Mar;23(2):131-141. doi: 10.1007/s40272-021-00440-8. Epub 2021 Mar 24.
Tumor necrosis factor alpha inhibitors (TNFi) are widely used in children with autoimmune and autoinflammatory conditions. Although TNFi are approved to treat psoriasis, they have also been shown to paradoxically induce psoriasiform lesions. In this review, we aim to focus on the clinical presentation and management of paradoxical psoriasis after exposure to TNFi in children with juvenile idiopathic arthritis (JIA), inflammatory bowel disease (IBD), or chronic nonbacterial osteomyelitis (CNO). A narrative review of the literature was performed given the limited number of publications on this topic. Children with IBD, CNO, and JIA have a higher risk of developing psoriasis at baseline, which increases after TNFi use in those with JIA and IBD. Risk factors for paradoxical psoriasis remain incompletely defined, and patients with IBD and/or CNO develop paradoxical psoriasis more commonly than those with JIA. Sex, race, and family history were not significantly associated with paradoxical psoriasis. The most commonly implicated TNFi include infliximab and adalimumab. Paradoxical psoriasis occurs in a similar distribution on the body to isolated psoriatic lesions and is morphologically indistinguishable. In many instances, topical therapies are effective in treating psoriasis and children can continue on TNFi for their primary disease. If lesions are severe or unacceptable to patients, TNFi may be switched or discontinued. Further research is needed to better characterize risk factors and understand the mechanism of disease pathogenesis. Pediatric health care providers who prescribe TNFi should counsel families regarding the risk of paradoxical psoriasis prior to starting the medication and monitor for new cutaneous eruptions.
肿瘤坏死因子α抑制剂（TNFi）广泛应用于患有自身免疫性和自身炎症性疾病的儿童。尽管TNFi被批准用于治疗银屑病，但也已显示其会反常地诱发银屑病样皮损。在本综述中，我们旨在聚焦于幼年特发性关节炎（JIA）、炎症性肠病（IBD）或慢性非细菌性骨髓炎（CNO）患儿在接触TNFi后反常性银屑病的临床表现及管理。鉴于关于该主题的出版物数量有限，我们对文献进行了叙述性综述。IBD、CNO和JIA患儿在基线时患银屑病的风险较高，在JIA和IBD患儿中使用TNFi后该风险会增加。反常性银屑病的危险因素仍未完全明确，IBD和/或CNO患者比JIA患者更常发生反常性银屑病。性别、种族和家族史与反常性银屑病无显著关联。最常涉及的TNFi包括英夫利昔单抗和阿达木单抗。反常性银屑病在身体上的分布与孤立性银屑病皮损相似，在形态上无法区分。在许多情况下，局部治疗对银屑病有效，患儿可继续使用TNFi治疗其原发性疾病。如果皮损严重或患者无法接受，可更换或停用TNFi。需要进一步研究以更好地描述危险因素并了解疾病发病机制。开具TNFi的儿科医疗服务提供者应在开始用药前就反常性银屑病的风险向家庭提供咨询，并监测新的皮肤疹。
