Center for Dermatology, Allergology and Dermatosurgery, Helios University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal, Germany.
Department of Dermatology, Venereology and Allergology, Helios St. Elisabeth Hospital Oberhausen, University of Witten/Herdecke, Oberhausen, Germany.
J Dermatolog Treat. 2023 Dec;34(1):2258240. doi: 10.1080/09546634.2023.2258240.
Although psoriasis and atopic dermatitis (AD) were for decades considered to be opposing diseases, it is now known that these skin conditions can coexist or even overlap in the same individual. Especially when using modern drugs with targeted IL inhibition, the balance between Th1 and Th2 immunity can be disturbed. In line with it, numerous clinical cases of AD have been induced by antipsoriatic biologics (e.g., TNF-alpha, IL-23, or IL-17 inhibitors), and IL-4-/IL-13 inhibition by dupilumab also resulted in paradoxical psoriasis in patients with AD. Herein, we describe a case of psoriasis vulgaris in a patient with intrinsic AD after systemic treatment with the anti-IL-13 antibody tralokinumab. We present a 36-years-old male patient with a severe course of an intrinsic atopic dermatitis and dyshidrotic hand eczema. He responded well to the therapy with tralokinumab. However, about 7 months after the start of anti-IL-13 treatment the patient developed psoriasiform lesions. The drug was then discontinued. Currently, the patient is receiving topical therapy with topical corticosteroids and calcineurin inhibitors with stable course of psoriasis and AD. This case suggests, that not only a dual IL-4-/IL-13-blockade, but also a selective IL-13-inhibition is able to skew immune responses toward IL-17 cytokine pathway-related disease. However, no clinical scores exist to predict the development of paradoxical psoriasis in patients with AD during therapy with biologics.
尽管银屑病和特应性皮炎（AD）在几十年前被认为是对立的疾病，但现在已知这些皮肤状况可以在同一患者中共存甚至重叠。特别是当使用具有靶向 IL 抑制作用的现代药物时，Th1 和 Th2 免疫之间的平衡可能会被打乱。与此一致，许多 AD 的临床病例是由抗银屑病生物制剂（例如 TNF-α、IL-23 或 IL-17 抑制剂）引起的，而 AD 患者中 IL-4/IL-13 抑制也导致了矛盾性银屑病。在此，我们描述了一名内在 AD 患者在全身接受抗 IL-13 抗体 tralokinumab 治疗后出现寻常型银屑病的病例。我们报告了一名 36 岁男性患者，他患有严重的特应性皮炎和汗疱疹性手部湿疹。他对 tralokinumab 的治疗反应良好。然而，在开始抗 IL-13 治疗大约 7 个月后，患者出现了银屑病样病变。然后停止了药物治疗。目前，该患者正在接受局部皮质类固醇和钙调神经磷酸酶抑制剂的局部治疗，银屑病和 AD 的病情稳定。该病例表明，不仅 IL-4/IL-13 双重阻断，而且选择性 IL-13 抑制也能够使免疫反应偏向于与 IL-17 细胞因子途径相关的疾病。然而，在使用生物制剂治疗 AD 患者期间，尚无预测矛盾性银屑病发展的临床评分。
