Majewski Michał, Konopelski Piotr, Rudnicka Lidia
Department of Dermatology, Medical University of Warsaw, Nowogrodzka 59, Warsaw, 02-014, Poland.
Arch Dermatol Res. 2025 Mar 17;317(1):582. doi: 10.1007/s00403-025-04132-y.
Plaque psoriasis is a common, chronic, papulosquamous skin disorder. TNF, IL-17 and IL-23 have been identified as key cytokines in the pathogenesis of psoriasis. Certain human leukocyte antigen (HLA) variants, such as HLA-Cw6 and HLA-B27, were proposed to affect the clinical course of the disease and the response to standard and biological treatment. In individuals positive for HLA-B27, psoriatic arthritis tends to progress more rapidly, with a higher prevalence of dactylitis and nail changes, suggesting HLA-B27 being a genetic biomarker for early-onset psoriatic arthritis. HLA-Cw6 is associated with the early onset of cutaneous manifestations in psoriasis. In these cases, cutaneous lesions are commonly localised on the chest and limbs, with less pronounced scalp and nail involvement. Psoriatic arthritis tends to develop later in HLA-Cw6-positive patients. The presence of HLA-Cw6 is associated with a more favourable therapeutic response to methotrexate and p40IL-12/23 inhibitors than to TNF inhibitors. Therefore, HLA-Cw6 testing may be a valuable tool for identifying patients who are likely to benefit from treatment with specific monoclonal antibodies, especially p40IL-12/23 inhibitors.
斑块状银屑病是一种常见的慢性丘疹鳞屑性皮肤病。肿瘤坏死因子（TNF）、白细胞介素-17（IL-17）和白细胞介素-23（IL-23）已被确定为银屑病发病机制中的关键细胞因子。某些人类白细胞抗原（HLA）变体，如HLA-Cw6和HLA-B27，被认为会影响疾病的临床进程以及对标准治疗和生物治疗的反应。在HLA-B27阳性个体中，银屑病关节炎往往进展更快，指（趾）炎和指甲改变的患病率更高，这表明HLA-B27是早发性银屑病关节炎的一种遗传生物标志物。HLA-Cw6与银屑病皮肤表现的早发有关。在这些病例中，皮肤病变通常位于胸部和四肢，头皮和指甲受累较轻。银屑病关节炎在HLA-Cw6阳性患者中往往较晚出现。与肿瘤坏死因子抑制剂相比，HLA-Cw6的存在与对甲氨蝶呤和p40IL-12/23抑制剂更有利的治疗反应相关。因此，HLA-Cw6检测可能是一种有价值的工具，用于识别可能从特定单克隆抗体治疗中获益的患者，尤其是p40IL-12/23抑制剂。
