Potestio Luca, Camela Elisa, Cacciapuoti Sara, Fornaro Luigi, Ruggiero Angelo, Martora Fabrizio, Battista Teresa, Megna Matteo
Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
Dermatology Unit, Istituto Dermopatico dell'Immacolata - IRCCS, Rome, Italy.
Clin Cosmet Investig Dermatol. 2023 Aug 4;16:2045-2059. doi: 10.2147/CCID.S407813. eCollection 2023.
Erythrodermic psoriasis (EP) is a severe and rare variant of psoriasis (less than 3% of cases), characterized by generalized scaling and erythema affecting more than 90% of body surface area. Several systemic symptoms can be present in patients with EP such as lymphadenopathy, arthralgia, fever, fatigue, dehydration, serum electrolyte disturbances, and tachycardia making this condition a possible life-threatening disease, particularly if appropriate treatments are not performed. In this scenario, effective and safe therapies are required. Unfortunately, the rarity of EP makes head-to-head Phase III trials challenging, leading to the lack of established guidelines for its management. Globally, conventional systemic drugs such as cyclosporine, methotrexate, and retinoids often have contraindications linked to patients' comorbidities and have not shown a high profile of efficacy and safety. Recently, the development of biologic drugs including anti-tumor necrosis factor-α and anti-interleukin 12-23, 23, and 17 has revealed favorable results for the management of plaque psoriasis, making them also a possible therapeutic option for EP disease. However, their use in EP is still off-label. The aim of our study was to review current literature on the use of biologic drugs for the treatment of EPs in order to offer a wide perspective on their possible application in EP management.
红皮病型银屑病（EP）是银屑病的一种严重且罕见的类型（病例占比不到3%），其特征为全身性脱屑和红斑，累及超过90%的体表面积。EP患者可能会出现多种全身症状，如淋巴结病、关节痛、发热、疲劳、脱水、血清电解质紊乱和心动过速，这使得该病症成为一种可能危及生命的疾病，尤其是在未进行适当治疗的情况下。在这种情况下，需要有效且安全的治疗方法。不幸的是，EP的罕见性使得进行直接对比的III期试验具有挑战性，导致缺乏针对其治疗的既定指南。在全球范围内，环孢素、甲氨蝶呤和维甲酸等传统全身性药物通常存在与患者合并症相关的禁忌证，并且尚未显示出高疗效和高安全性。最近，包括抗肿瘤坏死因子-α和抗白细胞介素12 - 23、23和17在内的生物药物的研发已显示出对斑块状银屑病治疗的良好效果，这也使它们成为EP疾病的一种可能治疗选择。然而，它们在EP中的使用仍属于超说明书用药。我们研究的目的是回顾当前关于使用生物药物治疗EP的文献，以便对其在EP治疗中的可能应用提供广泛的视角。
