Lugli Anna Paola, Caldarola Giacomo, Falco Gennaro Marco, Montedoro Costanza, Mulas Camilla, De Simone Clara
Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
Drugs Context. 2024 Jul 30;13. doi: 10.7573/dic.2024-4-3. eCollection 2024.
Bullous pemphigoid (BP) is an autoimmune bullous disease, typically affecting the elderly, characterized by the production of autoantibodies directed against structural components of the dermal-epidermal junction. An association between BP and psoriasis has been described several times, but the mechanisms underlying this association have yet to be clearly defined. The pathophysiological mechanism underlying psoriasis may be implicated in the pathogenesis of BP, as psoriasis precedes BP in most cases; in particular, a promoting role has been hypothesized by biologic therapies, which may induce a switch from a T helper 1 (T1)/T17-dominant cytokine milieu, typical of patients with psoriasis, to a T2-dominant one, typical of patients with BP. IL-17 inhibitors, in particular, have also been successfully used to treat BP in patients with psoriasis. The use of these drugs in these patients has been based on studies. However, cases of new-onset BP or relapses of BP already diagnosed in patients with psoriasis treated with biologic drugs have also been reported, and they occurred mainly in patients on anti-TNF drugs, yet very few cases with anti-IL-17A drugs have been described. We hereby describe two cases of new-onset BP in two patients treated with anti-IL-17 drugs for psoriasis.
大疱性类天疱疮（BP）是一种自身免疫性大疱性疾病，通常影响老年人，其特征是产生针对真皮-表皮交界处结构成分的自身抗体。BP与银屑病之间的关联已被多次描述，但这种关联的潜在机制尚未明确界定。银屑病的病理生理机制可能与BP的发病机制有关，因为在大多数情况下银屑病先于BP出现；特别是，生物疗法已被推测具有促进作用，它可能会促使从银屑病患者典型的T辅助细胞1（T1）/T17主导的细胞因子环境转变为BP患者典型的T2主导的环境。尤其是IL-17抑制剂，也已成功用于治疗合并银屑病的BP患者。这些药物在这些患者中的使用是基于研究。然而，也有报道称，在用生物药物治疗的银屑病患者中出现了新发BP或已诊断BP复发的病例，且主要发生在使用抗TNF药物的患者中，而使用抗IL-17A药物的病例描述很少。我们在此描述两例接受抗IL-17药物治疗银屑病的患者发生新发BP的病例。
