Zhou Qianqian, Zhou Shengru, Xiong Huizi, Yang Jianqiu, Yang Ziliang, Zhou Naihui, Mao Jinzhu, Li Min
Department of Dermatology, Dushu Lake Hospital Affiliated to Soochow University (Medical Center of Soochow University, Suzhou Dushu Lake Hospital), Suzhou, People's Republic of China.
Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
Clin Cosmet Investig Dermatol. 2023 Jun 12;16:1493-1497. doi: 10.2147/CCID.S412520. eCollection 2023.
Psoriasis is an immune-mediated chronic inflammatory skin disease. As our understanding of the pathogenesis of psoriasis has improved, biologic agents have become increasingly important in the treatment of psoriasis. However, the use of biologic agents is associated with cutaneous side effects. A new type of side effect called paradoxical reactions is an emerging threat arising from the increasing use of biologic agents.
Here, we present a case of paradoxical skin reactions - pyoderma gangrenosum (PG) and eczema - induced by biologic therapy. The case was successfully and eventually treated with baricitinib.
PG is a rare inflammatory disease characterised by painful and necrotic ulcerations containing neutrophils. It has been associated with autoimmune diseases such as inflammatory bowel disease (IBD). TNF (tumor necrosis factor) -α inhibitors can effectively treat refractory PG, while IL (interleukin) -17A inhibitors may worsen IBD symptoms. The cause of PG in this case was believed to be secukinumab, not adalimumab. The patient was diagnosed with eczematous dermatitis due to TNF-α inhibitors, and baricitinib was added to treat eczematous dermatitis.
Paradoxical reactions are unpredictable events that may occur during treatment with biologics at anytime. They need further research in order to formulate personalised treatment.
银屑病是一种免疫介导的慢性炎症性皮肤病。随着我们对银屑病发病机制的认识不断提高，生物制剂在银屑病治疗中变得越来越重要。然而，生物制剂的使用与皮肤副作用有关。一种名为矛盾反应的新型副作用正随着生物制剂使用的增加而成为一个新出现的威胁。
在此，我们报告一例由生物治疗引起的矛盾性皮肤反应——坏疽性脓皮病（PG）和湿疹的病例。该病例最终成功地用巴瑞替尼进行了治疗。
PG是一种罕见的炎症性疾病，其特征为含有中性粒细胞的疼痛性坏死性溃疡。它与自身免疫性疾病如炎症性肠病（IBD）有关。肿瘤坏死因子（TNF）-α抑制剂可有效治疗难治性PG，而白细胞介素（IL）-17A抑制剂可能会加重IBD症状。该病例中PG的病因被认为是司库奇尤单抗，而非阿达木单抗。患者因TNF-α抑制剂被诊断为湿疹性皮炎，并加用巴瑞替尼来治疗湿疹性皮炎。
矛盾反应是在生物制剂治疗期间随时可能发生的不可预测事件。它们需要进一步研究以制定个性化治疗方案。
