Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Department of Dermatology, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
J Dermatol. 2024 Jul;51(7):939-949. doi: 10.1111/1346-8138.17245. Epub 2024 Apr 25.
Systemic treatments are important for patients with moderate-to-severe psoriasis; however, they may occasionally cause adverse infectious events. Although the risk of severe infections with psoriatic treatments is well established, little is known about cutaneous infections. Therefore, we studied the frequency of cutaneous infections in patients with psoriasis who underwent biologic treatment. A total of 878 patients (237 females and 641 males) were analyzed in this follow-up survey conducted in 2020 and based on the Western Japan Psoriasis Registry. The observed skin phenotypes were psoriasis vulgaris (83.3%), pustular psoriasis (7.5%), and psoriatic arthritis (28.9%). The most frequently prescribed systemic drug was apremilast (11.3%), followed by ixekizumab (11.0%), risankizumab (10.9%), and secukinumab (10.4%). The incidence of cutaneous bacterial infections was 12 (1.37% of the total patients), with cellulitis being the most common (8/12, 67%). The incidence of viral infections was 11 (1.25%) including the most common, herpes zoster (9/11, 82%); and that of fungal infections was 45 (5.13%) including 33 (73%) and seven (16%) patients with trichophytosis and oral candidiasis, respectively. Multivariate analysis revealed that cutaneous bacterial infections were frequently observed in patients receiving tumor necrosis factor-α (odds raio [OR] 9.917, 95% confidence interval [CI] 2.069-47.572, p = 0.004) and interleukin (IL)-17 (OR 10.798, 95% CI 2.35-49.616, p = 0.002) inhibitor treatments. A history of otitis media and treatment with oral medications (OR 4.50, 95% CI 1.281-15.804, p = 0.019 and OR 3.80, 95% CI 1.141-12.679, p = 0.03 respectively) were associated with a higher ORs for cutaneous viral infections. Furthermore, age and use of IL-17 inhibitors were associated with elevated ORs for fungal infections. In conclusion, our study reveals that systemic therapies may increase the risk of cutaneous viral infections. Therefore, dermatologists should exercise caution in this regard.
系统性治疗对于中重度银屑病患者至关重要；然而，它们偶尔可能会引起不良的感染事件。虽然已有充分证据表明，接受银屑病治疗可能会引发严重感染，但对皮肤感染知之甚少。因此，我们研究了接受生物治疗的银屑病患者中皮肤感染的频率。在 2020 年进行的这项基于日本西部银屑病登记处的随访调查中，共分析了 878 例患者（237 例女性和 641 例男性）。观察到的皮肤表型包括寻常型银屑病（83.3%）、脓疱型银屑病（7.5%）和银屑病关节炎（28.9%）。最常开的系统性药物是阿普米司特（11.3%），其次是依奇珠单抗（11.0%）、瑞莎珠单抗（10.9%）和司库奇尤单抗（10.4%）。皮肤细菌感染的发生率为 12 例（占总患者的 1.37%），蜂窝织炎最为常见（8/12，67%）。病毒感染的发生率为 11 例（1.25%），包括最常见的带状疱疹（9/11，82%）；真菌感染的发生率为 45 例（5.13%），包括 33 例（73%）和 7 例（16%）的癣菌病和口腔念珠菌病患者。多变量分析显示，接受肿瘤坏死因子-α（比值比[OR]9.917，95%置信区间[CI]2.069-47.572，p=0.004）和白细胞介素（IL）-17（OR 10.798，95%CI 2.35-49.616，p=0.002）抑制剂治疗的患者更易发生皮肤细菌感染。中耳炎病史和口服药物治疗（OR 4.50，95%CI 1.281-15.804，p=0.019 和 OR 3.80，95%CI 1.141-12.679，p=0.03）与皮肤病毒感染的更高比值比（OR）相关。此外，年龄和使用 IL-17 抑制剂与真菌感染的更高 OR 相关。总之，我们的研究表明，系统性治疗可能会增加皮肤病毒感染的风险。因此，皮肤科医生应在此方面保持警惕。
