Trave Ilaria, Salvi Ilaria, Burlando Martina, Cozzani Emanuele, Parodi Aurora
Section of Dermatology, DISSAL, University of Genoa, IRCCS Ospedale Policlinico San Martino, 16044 Genova, Italy.
J Clin Med. 2023 Sep 29;12(19):6291. doi: 10.3390/jcm12196291.
Atopic dermatitis and psoriasis are traditionally considered diseases that cannot coexist, since they are described as the result of the activation of opposing inflammatory pathways. However, this belief has been debunked, and numerous cases of psoriasis induced by dupilumab, a biologic treatment for atopic dermatitis, have been reported. We report three cases of dupilumab-induced psoriasis and we present a literature review including cases of "de novo" psoriasis and of the relapse of psoriasis that occurred during treatment with dupilumab. In total, 39 publications met the inclusion criteria, including 112 AD patients, 101 of whom developed "de novo" psoriasis, and 11 with a flare of pre-existent psoriasis. In the first group, patients more frequently developed plaque psoriasis on the scalp and extremities, after an average latency period from the initiation of dupilumab of 5 months. In the second group, the incidence of dupilumab-induced relapses of psoriasis was 43%, after an average of 4 months since the first administration. The most common psoriasis type was plaque psoriasis, with the involvement of the scalp and upper extremities. Dupilumab was interrupted in 38% of patients with "de novo" psoriasis and in 50% of relapsed patients, leading, in most cases, to an improvement of psoriasis. In conclusion, atopic dermatitis and psoriasis can definitely co-exist, and biologic drugs used to treat the former can promote the latter. It is thus crucial to perform a careful personal and familiar anamnesis before prescribing any biologic treatment. Moreover, a study of cytokine expression and blood proteomic markers could be considered in these patients.
特应性皮炎和银屑病传统上被认为是不能共存的疾病，因为它们被描述为相反炎症途径激活的结果。然而，这一观点已被推翻，已有大量关于度普利尤单抗（一种用于治疗特应性皮炎的生物制剂）诱发银屑病的病例报道。我们报告了3例度普利尤单抗诱发的银屑病病例，并对文献进行了综述，包括“新发”银屑病病例以及在度普利尤单抗治疗期间银屑病复发的病例。共有39篇出版物符合纳入标准，包括112例特应性皮炎患者，其中101例发生了“新发”银屑病，11例既往存在的银屑病病情加重。在第一组中，患者在开始使用度普利尤单抗平均5个月的潜伏期后，头皮和四肢更常出现斑块状银屑病。在第二组中，度普利尤单抗诱发的银屑病复发率为43%，自首次给药平均4个月后出现。最常见的银屑病类型是斑块状银屑病，累及头皮和上肢。38%的“新发”银屑病患者和50%的复发患者中断了度普利尤单抗治疗，在大多数情况下，这导致银屑病病情改善。总之，特应性皮炎和银屑病肯定可以共存，用于治疗前者的生物药物可促使后者发生。因此，在开具任何生物治疗药物之前，仔细询问个人和家族病史至关重要。此外，可考虑对这些患者进行细胞因子表达和血液蛋白质组学标志物研究。
