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新发触发因素背景下的红皮病型银屑病:度普利尤单抗相关及新冠病毒诱导的银屑病性疾病解析

Erythrodermic Psoriasis in the Context of Emerging Triggers: Insights into Dupilumab-Associated and COVID-19-Induced Psoriatic Disease.

作者信息

Fadel Aya, Nithura Jayakumar, Saadoon Zahraa F, Naseer Lamia, Lopez-Lacayo Angelo, Rojas Solano Ligia Elena, Palau Morales Chaveli, Hernandez Robert J, Hussain Hussain

机构信息

Department of Internal medicine, HCA Florida Kendall Hospital, Miami, FL 33175, USA.

Department of Internal Medicine, Hackensack Meridian Hospital, Ocean University Medical Center, Brick, NJ 08724, USA.

出版信息

Dermatopathology (Basel). 2025 Jun 9;12(2):17. doi: 10.3390/dermatopathology12020017.

Abstract

Psoriasis is a chronic immune-mediated inflammatory skin disorder characterized by keratinocyte hyperproliferation, impaired epidermal barrier function, and immune dysregulation. The Th17/IL-23 axis plays a central role in its pathogenesis, promoting the production of key pro-inflammatory cytokines such as IL-17, IL-23, and TNF-α, which sustain chronic inflammation and epidermal remodeling. Emerging evidence suggests that SARS-CoV-2 may trigger new-onset or exacerbate existing psoriasis, likely through viral protein-induced activation of toll-like receptors (TLR2 and TLR4). This leads to NF-κB activation, cytokine release, and enhanced Th17 responses, disrupting immune homeostasis. Erythrodermic psoriasis (EP), a rare and severe variant, presents with generalized erythema and desquamation, often accompanied by systemic complications, including infection, electrolyte imbalance, and hemodynamic instability. In a murine model of SARS-CoV-2 infection, we found notable cutaneous changes: dermal collagen deposition, hair follicle destruction, and subcutaneous adipose loss. Parallel findings were seen in a rare clinical case (only the third reported case) of EP in a patient with refractory psoriasis, who developed erythroderma after off-label initiation of dupilumab therapy. The patient's histopathology closely mirrored the changes seen in the SARS-CoV-2 model. Histological evaluations also reveal similarities between psoriasis flare-ups following dupilumab treatment and cutaneous manifestations of COVID-19, suggesting a shared inflammatory pathway, potentially mediated by heightened type 1 and type 17 responses. This overlap raises the possibility of a latent connection between SARS-CoV-2 infection and increased psoriasis severity. Since the introduction of COVID-19 vaccines, sporadic cases of EP have been reported post-vaccination. Although rare, these events imply that vaccine-induced immune modulation may influence psoriasis activity. Our findings highlight a convergence of inflammatory mediators-including IL-1, IL-6, IL-17, TNF-α, TLRs, and NF-κB-across three triggers: SARS-CoV-2, vaccination, and dupilumab. Further mechanistic studies are essential to clarify these relationships and guide management in complex psoriasis cases.

摘要

银屑病是一种慢性免疫介导的炎症性皮肤病,其特征为角质形成细胞过度增殖、表皮屏障功能受损和免疫失调。Th17/IL-23轴在其发病机制中起核心作用,促进关键促炎细胞因子如IL-17、IL-23和TNF-α的产生,这些细胞因子维持慢性炎症和表皮重塑。新出现的证据表明,严重急性呼吸综合征冠状病毒2(SARS-CoV-2)可能引发新发银屑病或加重现有银屑病,可能是通过病毒蛋白诱导Toll样受体(TLR2和TLR4)激活。这导致核因子κB(NF-κB)激活、细胞因子释放和Th17反应增强,破坏免疫稳态。红皮病型银屑病(EP)是一种罕见的严重类型,表现为全身红斑和脱屑,常伴有全身并发症,包括感染、电解质失衡和血流动力学不稳定。在SARS-CoV-2感染的小鼠模型中,我们发现了显著的皮肤变化:真皮胶原沉积、毛囊破坏和皮下脂肪丢失。在一名难治性银屑病患者发生红皮病的罕见临床病例(仅第三例报道病例)中也观察到了类似的结果,该患者在超说明书使用度普利尤单抗治疗后出现了红皮病。患者的组织病理学与SARS-CoV-2模型中的变化极为相似。组织学评估还揭示了度普利尤单抗治疗后银屑病发作与冠状病毒病2019(COVID-19)皮肤表现之间的相似性,提示存在共同的炎症途径,可能由增强的1型和17型反应介导。这种重叠增加了SARS-CoV-2感染与银屑病严重程度增加之间潜在联系的可能性。自冠状病毒病2019疫苗引入以来,已报告接种疫苗后出现散发性EP病例。尽管罕见,但这些事件表明疫苗诱导的免疫调节可能影响银屑病活动。我们的研究结果突出了包括IL-1、IL-6、IL-17、TNF-α、TLR和NF-κB在内的炎症介质在三种触发因素(SARS-CoV-2、疫苗接种和度普利尤单抗)中的汇聚。进一步的机制研究对于阐明这些关系并指导复杂银屑病病例的管理至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/67a1/12192188/0da196a48432/dermatopathology-12-00017-g001.jpg

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