Department of Dermatology, Pamukkale University, Denizli, Turkey.
Department of Rheumatology, Denizli State Hospital, Denizli, Turkey.
Int J Rheum Dis. 2024 Jan;27(1):e14854. doi: 10.1111/1756-185X.14854. Epub 2023 Jul 31.
Tumor necrosis factor alpha (TNFα) inhibitors are now widely used to treat immune-mediated inflammatory diseases. Although they have a good safety profile, they are also associated with adverse cutaneous events. Pigmented purpuric dermatoses (PPD) include a variety of skin diseases characterized by multiple petechial hemorrhages due to capillaritis. Five major clinical types of PPD have been described and purpura annularis telangiectodes of Majocchi (PATM) is a rare subtype of PPD. The cause of PPD is unknown, but drugs are implicated in a minority of cases. There are very few cases in the literature triggered by TNFα inhibitors. We present a case of PATM induced by certolizumab pegol and perform a review including 4 articles in the literature reporting 5 PPD cases induced by TNFα inhibitors. When purpuric eruptions develop in patients treated with TNFα inhibitors, PPD and vasculitis should be differentiated. Thus, patients are not exposed to unnecessary evaluations and treatments.
肿瘤坏死因子-α（TNFα）抑制剂现在被广泛用于治疗免疫介导的炎症性疾病。虽然它们具有良好的安全性，但也与不良皮肤事件有关。色素性紫癜性皮肤病（PPD）包括多种以毛细血管炎引起的多发性瘀点为特征的皮肤疾病。已经描述了 PPD 的五种主要临床类型，而 Majocchi 的环状紫癜性毛细血管扩张症（PATM）是 PPD 的一种罕见亚型。PPD 的病因不明，但少数情况下与药物有关。文献中很少有 TNFα 抑制剂引发的病例。我们报告了一例由培戈珠单抗引起的 PATM，并进行了综述，包括文献中的 4 篇文章，报告了 5 例 TNFα 抑制剂引起的 PPD 病例。当接受 TNFα 抑制剂治疗的患者出现紫癜性皮疹时，应区分 PPD 和血管炎。因此，患者不会接受不必要的评估和治疗。
