Weiss Lina, Marbet Corinne Punsap, Branca Lorenzo Barino, Mühleisen Beda, Navarini Alexander
Department of Dermatology and Venerology, University Hospital Basel, Basel, Switzerland.
Case Rep Dermatol. 2024 Jun 17;16(1):144-148. doi: 10.1159/000539124. eCollection 2024 Jan-Dec.
After the introduction of dupilumab as systemic treatment for atopic dermatitis, an increasing number of patients have been successfully treated. However, reports of patients developing psoriasis as a secondary skin condition have been accumulating. The most likely reason is assumed to be an immune shift from Th2- to Th1-mediated auto-inflammatory processes.
Our patient is a 38-year-old male suffering from head-neck type atopic dermatitis since childhood. As one of the first patients in Switzerland, he received dupilumab in 2018 leading to a significant improvement of his skin lesions. One year later he developed progressing circular erythematous-squamous plaques which correlated histologically with psoriasis. In 2021, 3 years after initiating dupilumab, we switched systemic therapy to baricitinib. Three months after initiation, his psoriatic lesions were completely healed, while the atopic lesions remained stable with low inflammatory activity.
In patients treated with dupilumab for atopic dermatitis immune shift needs to be considered in case of newly appearing skin lesions. With a growing number of described cases, we conclude that baricitinib is a good alternative treatment for atopic dermatitis in patients suffering from biologic-induced psoriasis.
在引入度普利尤单抗作为特应性皮炎的全身治疗药物后，越来越多的患者得到了成功治疗。然而，患者继发银屑病作为一种皮肤疾病的报告不断积累。最可能的原因被认为是免疫从Th2介导的炎症过程向Th1介导的自身炎症过程转变。
我们的患者是一名38岁男性，自幼患有头颈型特应性皮炎。作为瑞士首批患者之一，他于2018年接受了度普利尤单抗治疗，皮肤病变得到显著改善。一年后，他出现了进行性圆形红斑鳞屑斑块，组织学检查与银屑病相符。在开始使用度普利尤单抗3年后的2021年，我们将全身治疗改为巴瑞替尼。开始治疗3个月后，他的银屑病病变完全愈合，而特应性病变在低炎症活动下保持稳定。
在接受度普利尤单抗治疗特应性皮炎的患者中，如果出现新的皮肤病变，需要考虑免疫转变。随着越来越多病例的报道，我们得出结论，巴瑞替尼是患有生物制剂诱导的银屑病的特应性皮炎患者的一种良好替代治疗方法。
