David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Dermatol Ther. 2022 Feb;35(2):e15234. doi: 10.1111/dth.15234. Epub 2021 Dec 8.
Biologic medications are systemic therapeutic options for inflammatory dermatoses. Local forms of administration are less well-studied. To provide a summary of intralesional (IL) administration of biologics for various non-malignant inflammatory dermatologic conditions reported in the literature. A systematic review was performed in the PubMed and Embase databases from 2000 to 2020. Inclusion criteria included the local use of biologic medications for non-malignant cutaneous conditions. Quality was assessed with the modified Oxford Centre for Evidence-Based Medicine ratings. A total of 19 articles describing the use of 5 biologic medications in 9 dermatologic conditions were identified, comprising 172 patients. Conditions successfully treated with intralesional biologics included pemphigus vulgaris (rituximab), granuloma faciale (rituximab), perianal Crohn's disease (infliximab), lichen sclerosus (adalimumab), and necrobiosis lipoidica (etanercept and infliximab). Intralesional etanercept reduced pruritus associated with keloids. A case report of the use of infliximab for pyoderma gangrenosum did not demonstrate any efficacy. There was no consistent effect noted with treatments for sarcoidosis (infliximab) or cutaneous lymphoid hyperplasia (rituximab). Local administration of biologic medications may offer an additional method of treating refractory inflammatory dermatoses, but further study is needed to develop standardized dosing protocols, clarify efficacy rates, and identify optimal treatment candidates.
生物制剂是治疗炎症性皮肤病的全身性治疗选择。局部给药形式的研究较少。本文旨在对文献中报道的各种非恶性炎症性皮肤病的皮损内（IL）给予生物制剂的方法进行总结。在 2000 年至 2020 年期间，在 PubMed 和 Embase 数据库中进行了系统评价。纳入标准包括局部使用生物制剂治疗非恶性皮肤疾病。采用改良牛津循证医学中心评分评估质量。共确定了 19 篇描述 5 种生物制剂在 9 种皮肤病中的应用的文章，共纳入 172 例患者。皮损内生物制剂成功治疗的疾病包括寻常型天疱疮（利妥昔单抗）、颜面肉芽肿（利妥昔单抗）、肛周克罗恩病（英夫利昔单抗）、硬化性苔藓（阿达木单抗）和坏死性脂膜炎（依那西普和英夫利昔单抗）。皮损内给予依那西普可减轻瘢痕疙瘩相关的瘙痒。英夫利昔单抗治疗坏疽性脓皮病的病例报告未显示出任何疗效。对于结节病（英夫利昔单抗）或皮肤淋巴组织增生（利妥昔单抗）的治疗，没有观察到一致的效果。生物制剂的局部给药可能为治疗难治性炎症性皮肤病提供了另一种方法，但需要进一步研究来制定标准化的给药方案、明确疗效率，并确定最佳治疗候选者。
