Joint Rheumatology Program, 1st Department of Propaedeutic Internal Medicine-Rheumatology Unit, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Ag. Thoma 17, 11527, Athens, Greece.
Joint Rheumatology Program, 1st Department of Propaedeutic Internal Medicine-Rheumatology Unit, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Ag. Thoma 17, 11527, Athens, Greece, 1st University Clinic, Department of Dermatology-Venereology, National and Kapodistrian University of Athens, School of Medicine, A. Sygros Hospital, I. Dragoumi 5, 16121, Athens, Greece.
Eur J Dermatol. 2021 Jun 1;31(3):307-317. doi: 10.1684/ejd.2021.4056.
New onset or exacerbation of pre-existing psoriasis after therapeutic TNF-α inhibition is a well-described phenomenon. Over the last two decades, similar cases of paradoxical psoriasis have been reported following the administration of other biologic agents. We aimed to review all published cases of induced or exacerbated psoriasis after biologic therapy other than anti-TNF-α agents in order to further elucidate the pathophysiology of this phenomenon. A systematic literature review in the Medline database regarding any relevant case series or case reports on new onset or exacerbation of psoriasis after the administration of biologic agents targeting B cells, T cell co-stimulation, interleukin-1, interleukin-6, interleukin-17 and interleukin-12/23 was performed using appropriate key words. The literature search revealed nine articles (nine cases) of paradoxical psoriasis after ustekinumab and eight articles (nine cases) after secukinumab administration, both of which are approved therapies for psoriasis Moreover, 15 articles (23 cases) for rituximab, nine articles (12 cases) for abatacept, eight articles (nine cases) for tocilizumab, and one case report for anakinra have been published. In the majority of cases, patients had no prior history of psoriasis while 18 patients presented with exacerbation of pre-existing psoriatic lesions. Paradoxical psoriasis is not a specific adverse event of TNF-α inhibitors but is a possible side effect of any biologic agent interfering with the immune system. Awareness among physicians regarding early recognition is mandatory. Further clinical and experimental data are needed in order to unravel the pathophysiology of this unexpected phenomenon.
新发病例或恶化已存在的银屑病后治疗 TNF-α 抑制是一个很好的描述的现象。在过去的二十年中，类似的情况下，矛盾性银屑病已报告后管理的其他生物制剂。我们的目的是审查所有发表的病例诱导或恶化银屑病后生物治疗以外的抗 TNF-α 制剂，以进一步阐明发病机制的这种现象。一个系统的文献回顾在 Medline 数据库中有关任何相关的病例系列或病例报告对新发病例或恶化银屑病后管理生物制剂针对 B 细胞，T 细胞共刺激，白细胞介素-1，白细胞介素-6，白细胞介素-17 和白细胞介素-12/23 使用适当的关键词。文献检索显示九个文章（九个病例）的矛盾性银屑病后乌司奴单抗和八篇文章（九个病例）后司库奇尤单抗给药，这两种药物都是银屑病的批准治疗方法。此外，15 篇文章（23 例）利妥昔单抗，九篇文章（12 例）阿巴西普，八篇文章（九个病例）托珠单抗，和一个病例报告为 anakinra 已发表。在大多数情况下，患者没有既往史的银屑病而 18 例患者提出了恶化的已有银屑病皮损。矛盾性银屑病不是一个特定的不良事件的 TNF-α 抑制剂，但可能是一个副作用的任何生物制剂干扰免疫系统。认识到医生对早期识别是强制性的。进一步的临床和实验数据是必要的，以揭示发病机制的这种意外现象。
