Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Cutis. 2022 Feb;109(2):110-112. doi: 10.12788/cutis.0453.
Psoriasis vulgaris, a helper T cell T1/T17-mediated inflammatory dermatosis, may be effectively treated with biologic medications such as secukinumab, an IL-17A inhibitor. However, suppression of the T1-mediated axis may result in the paradoxical appearance of T2-mediated inflammatory skin conditions, such as atopic dermatitis (AD). Dupilumab, a biologic medication that inhibits IL-4/IL-13-cytokines involved in T2-mediated inflammation-has demonstrated efficacy in treating AD but may result in phenotypic switching to psoriasis. We describe a patient with psoriasis that was well controlled on secukinumab who developed severe AD that improved with dupilumab. After several months of effective treatment with dupilumab, he subsequently developed re-emergence of psoriatic lesions. This case highlights how pharmacologic interventions targeted at specific immunologic pathways, such as the T1/T2 axis, may have unintended consequences.
寻常型银屑病是一种由辅助性 T 细胞 T1/T17 介导的炎症性皮肤病，可通过生物制剂如 IL-17A 抑制剂司库奇尤单抗进行有效治疗。然而，T1 介导的轴抑制可能导致 T2 介导的炎症性皮肤疾病，如特应性皮炎 (AD) 的出现。Dupilumab 是一种生物制剂，可抑制 IL-4/IL-13 细胞因子，这些细胞因子参与 T2 介导的炎症，已被证明在治疗 AD 方面有效，但可能导致表型向银屑病转化。我们描述了一名患者在使用司库奇尤单抗治疗银屑病时病情得到了很好的控制，随后他出现了严重的 AD，而使用 dupilumab 后得到了改善。在使用 dupilumab 有效治疗几个月后，他随后又出现了银屑病病变的复发。这个病例强调了针对特定免疫途径（如 T1/T2 轴）的药物干预可能会产生意想不到的后果。
