Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Department of Medicine, Schulich School of Medicine, Western University, London, Ontario, Canada.
Aliment Pharmacol Ther. 2022 Jun;55(11):1379-1388. doi: 10.1111/apt.16883. Epub 2022 Mar 21.
Tumour necrosis factor (TNF) antagonists are an efficacious therapy used in the management of several immune-mediated inflammatory diseases, including inflammatory bowel disease (IBD) and psoriasis. However, since being prescribed more widely, reports of new-onset psoriatic lesions have began to emerge in the literature and are known as paradoxical psoriasis.
To review the evidence available in both the dermatology and gastroenterology literature pertaining to the entity known as paradoxical psoriasis as it relates to IBD and to create a comprehensive guide to assist clinicians who treat this challenging patient population.
A literature search was conducted in PubMed to identify manuscripts that presented, discussed or summarised data pertaining to paradoxical psoriasis presenting in individuals with IBD.
Paradoxical psoriasis is now thought to be a contradictory effect of TNF antagonist therapy leading to psoriatic lesions often within the first year of treatment. The underlying pathogenesis, although not completely understood, is likely related to an imbalance of inflammatory cytokines. The histological appearance, while similar to classical psoriasis, does have unique features. The clinical presentation can vary among patients but often presents during maintenance therapy for inflammatory bowel disease. Treatment options should be determined based upon the severity of the skin lesion, activity of the underlying inflammatory bowel disease and the patient's unique clinical history.
The approach to paradoxical psoriasis in IBD should be discussed with a multidisciplinary team to optimise and preserve intestinal disease remission and to ensure the resolution of debilitating skin lesions.
肿瘤坏死因子（TNF）拮抗剂是一种有效的治疗方法，用于治疗多种免疫介导的炎症性疾病，包括炎症性肠病（IBD）和银屑病。然而，自从广泛应用以来，文献中开始出现新的银屑病病变的报告，被称为矛盾性银屑病。
回顾皮肤科和胃肠病学文献中关于与 IBD 相关的矛盾性银屑病的现有证据，并制定一份综合指南，以帮助治疗这一具有挑战性的患者群体的临床医生。
在 PubMed 上进行文献检索，以确定提出、讨论或总结与 IBD 患者中出现的矛盾性银屑病相关数据的手稿。
目前认为矛盾性银屑病是 TNF 拮抗剂治疗的矛盾作用，导致银屑病病变通常在治疗的第一年出现。虽然发病机制尚未完全理解，但可能与炎症细胞因子失衡有关。虽然组织学表现与经典银屑病相似，但仍具有独特的特征。临床表现在患者之间可能有所不同，但通常在维持治疗炎症性肠病期间出现。治疗选择应根据皮肤病变的严重程度、潜在炎症性肠病的活动情况和患者独特的临床病史来确定。
应与多学科团队讨论 IBD 中的矛盾性银屑病的治疗方法，以优化和维持肠道疾病缓解，并确保消除使人衰弱的皮肤病变。
