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Potestio L, Camela E, Cacciapuoti S, Fornaro L, Ruggiero A, Martora F, Battista T, Megna M. Biologics for the Management of Erythrodermic Psoriasis: An Updated Review. Clin Cosmet Investig Dermatol 2023; 16:2045-2059. [PMID: 37560255 PMCID: PMC10408653 DOI: 10.2147/ccid.s407813] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
Erythrodermic psoriasis (EP) is a severe and rare variant of psoriasis (less than 3% of cases), characterized by generalized scaling and erythema affecting more than 90% of body surface area. Several systemic symptoms can be present in patients with EP such as lymphadenopathy, arthralgia, fever, fatigue, dehydration, serum electrolyte disturbances, and tachycardia making this condition a possible life-threatening disease, particularly if appropriate treatments are not performed. In this scenario, effective and safe therapies are required. Unfortunately, the rarity of EP makes head-to-head Phase III trials challenging, leading to the lack of established guidelines for its management. Globally, conventional systemic drugs such as cyclosporine, methotrexate, and retinoids often have contraindications linked to patients' comorbidities and have not shown a high profile of efficacy and safety. Recently, the development of biologic drugs including anti-tumor necrosis factor-α and anti-interleukin 12-23, 23, and 17 has revealed favorable results for the management of plaque psoriasis, making them also a possible therapeutic option for EP disease. However, their use in EP is still off-label. The aim of our study was to review current literature on the use of biologic drugs for the treatment of EPs in order to offer a wide perspective on their possible application in EP management.
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Affiliation(s)
- Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Elisa Camela
- Dermatology Unit, Istituto Dermopatico dell’Immacolata - IRCCS, Rome, Italy
| | - Sara Cacciapuoti
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luigi Fornaro
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Angelo Ruggiero
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabrizio Martora
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Teresa Battista
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Yu C, Wu C, Yang Y, Jin H. Systemic monotherapy with acitretin for erythrodermic psoriasis: results of a retrospective study of 81 patients. Ther Adv Chronic Dis 2023; 14:20406223231178412. [PMID: 37360416 PMCID: PMC10286161 DOI: 10.1177/20406223231178412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 05/10/2023] [Indexed: 06/28/2023] Open
Abstract
Background Erythrodermic psoriasis (EP) remains challenging to manage because it is rare and has complex complications. Although acitretin is recommended as an appropriate choice for EP, there is a lack of large-scale evidence. Objectives This study aims to assess the efficacy and safety of acitretin as systemic monotherapy in EP patients. Design We retrospectively analyzed data from patients with EP who received at least 3 months of acitretin as systemic monotherapy during hospitalization and out-patient follow-up from January 2005 to May 2021 at the Peking Union Medical College Hospital, China. Methods The efficacy was clinically evaluated after 1, 2, 4, and 12 weeks of treatment, which was classified as a good response (>75% of lesions cleared), partial response (50%-75% cleared), moderate response (25-50% cleared), or no response (<25% cleared). Safety was assessed on the basis of physical examination results and significant changes in laboratory examination results after 12 weeks of treatment. Results Overall, 81 patients (79.0% men; mean age, 47.9 years) were included. The acitretin dose ranged from 20 to 60 mg/day (0.3 to 0.8 mg/kg/day). The rates of good, partial, and moderate responses were 0.0%, 2.5%, and 42.0% at 1 week; 3.7%, 34.6%, and 61.7% at 2 weeks; 29.6%, 58.0%, and 12.4% at 4 weeks; and 85.2%, 13.6%, and 1.2% at 12 weeks after treatment initiation, respectively. EP patients transformed from psoriasis vulgaris showed a higher good/partial response rate compared with that of EP patients that developed from pustular or articular psoriasis (44.6% vs. 14.3%, p = 0.035). Patients with concurrent infection showed a lower rate of good/partial response compared with that of those without concurrent infection (16.7% vs. 44.4%, p = 0.049). Adverse effects were seen in 45 (55.6%) patients in 12 weeks, and dyslipidemia (n = 31; 38.3%), xerosis (n = 24; 29.6%), and elevated liver enzymes (n = 6; 7.4%) were most commonly reported. Twenty-three patients were followed up for over 3 years, and six (26.1%) patients had EP recurrence. Conclusions Acitretin as a systemic monotherapy showed satisfactory effectiveness for EP, especially in patients developed from psoriasis vulgaris and without infection.
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Affiliation(s)
- Chenyang Yu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Chao Wu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Yuyan Yang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Hongzhong Jin
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, No. 1 Shuai Fu Yuan Street, Beijing 100730, China
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Abstract
INTRODUCTION Erythrodermic psoriasis (EP) is an extreme and potentially life-threatening form of psoriasis in which most or all of the body surface area is affected by psoriasis. It occurs in 1-2% of patients with psoriasis and is less responsive to conventional therapies. Biologics have shown promise in the management of EP. AREAS COVERED This review briefly discusses the pathophysiology of EP. Current evidence on established and emerging targeted therapies for EP is covered, including anti-TNF-α biologics, IL-12/23, IL-17, and IL-23 inhibitors. EXPERT OPINION The need for rapidly acting, safe, and efficacious agents in EP has been met with advent of newer biologics, particularly IL-17 and IL-23 inhibitors. These targeted approaches warrant consideration as first-line management option for the management of EP; however, high-quality evidence regarding their long-term efficacy and safety in EP is lacking. Novel biologics such as bimekizumab and mirikizumab, and nanobodies such as netakimab and sonelokimab have shown promise in the management of plaque psoriasis, and potential of these molecules in management of EP should be explored. Management of patients with prior biologic failure remains a challenge. Guidelines for the management of EP need to be revisited in light of the recent advances.
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Affiliation(s)
- Sunil Dogra
- Department of Dermatology, Venereology and Leprology; Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hitaishi Mehta
- Department of Dermatology, Venereology and Leprology; Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kudsi M, Alzabibi MA, Shibani M. Two cases of Erythrodermic psoriasis treated with Golimumab. Ann Med Surg (Lond) 2022; 78:103961. [PMID: 35734731 PMCID: PMC9207129 DOI: 10.1016/j.amsu.2022.103961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 12/29/2022] Open
Abstract
Introduction and importance Erythrodermic psoriasis (EP) is a very severe subtype of psoriasis, with a challenge poses in its treatment, as currently available therapies often provide unsatisfactory results, for those many biologics have been used in the treatment of EP such as Golimumab which has been extensively studied for the treatment of psoriatic arthritis, and chronic plaque psoriasis. However, no clinical trials have been performed for EP. Case presentation We report two cases of a 23-year old female, and a 31-year male who presented with severe psoriasis that previously un respond to ultraviolet B phototherapy, methotrexate, cyclosporine, and topical agents. Skin lesions worsened progressively and developed into erythroderma. Therefore, we administered golimumab 50 mg, which lead to the improvement of the skin lesions according to the Psoriasis Area and Severity Index score after the first administration; lesions improved further throughout the treatment course. Conclusion Golimumab may be an alternative treatment for Erythrodermic psoriasis patients unrespond to other treatments even it did not have the FDA approval, so this is an off label indication and treatment. Erythrodermic psoriasis is a very severe subtype of psoriasis, with a challenge poses in its treatment. Golimumab is tumor necrosis factor inhibitors. Golimumab is FDA approved treatment for psoriatic arthritis, and chronic plaque psoriasis. However, no clinical trials have been performed for the treatment of erythrodermic psoriasis.
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Affiliation(s)
- Mayssoun Kudsi
- Faculty of Medicine, Syrian Private University, Damascus, Syria.,Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Mosa Shibani
- Faculty of Medicine, Syrian Private University, Damascus, Syria
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Hadeler E, Mosca M, Hong J, Brownstone N, Liao W, Bhutani T, Shinkai K. Inpatient Management of Psoriasis: A Current Perspective and Update for Clinicians. CURRENT DERMATOLOGY REPORTS 2021. [DOI: 10.1007/s13671-021-00342-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lo Y, Tsai TF. Updates on the Treatment of Erythrodermic Psoriasis. PSORIASIS (AUCKLAND, N.Z.) 2021; 11:59-73. [PMID: 34136373 PMCID: PMC8200157 DOI: 10.2147/ptt.s288345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/20/2021] [Indexed: 12/30/2022]
Abstract
Erythrodermic psoriasis (EP) is a rare variant of psoriasis, which is potentially life threatening and often resistant to conventional therapy. Biologics have revolutionized the treatment of plaque-type psoriasis, and shown promise in EP. However, due to the lack of head-to-head studies and the rarity of EP, no high level evidence-based treatment guidelines for EP have been established, and the evidence of treatment of EP is limited to case reports or small case series. Here, we present a narrative review focusing on the up-to-date information for the treatment of EP.
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Affiliation(s)
- Yang Lo
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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7
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Fisher S, Ziv M. Skin and soft tissue infections in biological therapy for psoriasis-A case report and systematic review of the literature. Int J Dermatol 2021; 60:1429-1434. [PMID: 34080684 DOI: 10.1111/ijd.15679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/04/2021] [Accepted: 05/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Biological therapies are widely used for moderate to severe chronic plaque psoriasis owing to their high efficacy and safety profile. However, skin and soft tissue infections (SSTIs) have been reported in association with biological treatment in psoriasis. METHODS We report a case of necrotizing fasciitis in an 18-year-old psoriasis patient with a history of severe combined immunodeficiency treated with secukinumab and conducted a systematic literature review of SSTIs associated with biological therapy for psoriasis. The literature review related to biological therapies for psoriasis between the years 1990 and 2020: Medline (PubMed), Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched for psoriasis, biological treatment, and skin and soft tissue infections. RESULTS Over 1,300 titles were found, 24 of which met the inclusion criteria for our study: nine retrospective studies, nine randomized controlled trials, and six prospective studies. The data covered 10 biological treatments. More than 40,000 patients receiving biological treatment were included, and nearly 1,000 cases of SSTIs were documented. CONCLUSIONS We present the available records regarding SSTIs among chronic plaque psoriasis patients given biological treatment. Most reported SSTIs were related to psoriasis patients treated with TNF-α inhibitors. In view of the presented data, biological treatment appears to be a safe mode of therapy for this aspect of psoriasis.
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Affiliation(s)
- Shani Fisher
- Dermatology and Venereology Department, Emek Medical Center, Afula, Israel.,Department of Nursing, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Ziv
- Dermatology and Venereology Department, Emek Medical Center, Afula, Israel
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Chat VS, Uppal SK, Kearns DG, Wu JJ. Comparison of guidelines for the use of Ustekinumab for psoriasis in the United States, Europe, and the United Kingdom: A critical appraisal and comprehensive review. Dermatol Ther 2021; 34:e14974. [PMID: 33991048 DOI: 10.1111/dth.14974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/05/2021] [Accepted: 05/12/2021] [Indexed: 11/28/2022]
Abstract
The aim of this review is to compare and contrast evidence-based clinical practice guidelines from global dermatological organizations for the use of ustekinumab in psoriasis. Clinical practice guidelines from the American Academy of Dermatology, National Psoriasis Foundation, British Association of Dermatologists, and European S3 were reviewed and compared. Practice guidelines from the three dermatological organizations are similar with regards to treatment dosage and initiation but differ in their recommendations for baseline screening and interval laboratory monitoring, treatment in patients undergoing surgery or receiving live vaccines, and treatment contraindications. Ustekinumab is an effective and well-tolerated systemic treatment for patients with psoriasis and should be considered in the line of therapy that dermatologists discuss with their patients. Consideration should be given to evidence-based practice guidelines of global dermatology organizations to effectively guide treatment decisions in patients with psoriasis.
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Affiliation(s)
- Vipawee S Chat
- Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | | | - Donovan G Kearns
- Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California, USA
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Ozcan I, Karadag AS, Ceren E, Demirci B, Cebeci F. A case of erythrodermic psoriasis in which adalimumab injection sites are preserved. Dermatol Ther 2021; 34:e14865. [PMID: 33569858 DOI: 10.1111/dth.14865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/17/2021] [Accepted: 02/05/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ilknur Ozcan
- Department of Dermatology, Istanbul Medeniyet University School of Medicine Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | | | - Eylem Ceren
- Department of Dermatology, Health Science University, Fatih Sultan Mehmet Hospital, Istanbul, Turkey
| | - Busra Demirci
- Department of Dermatology, Istanbul Medeniyet University School of Medicine Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Filiz Cebeci
- Department of Dermatology, Istanbul Medeniyet University School of Medicine Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
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10
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Liu LC, Jin XH, Sun C, Xia JX. Two cases of refractory erythrodermic psoriasis effectively treated with secukinumab and a review of the literature. Dermatol Ther 2021; 34:e14825. [PMID: 33527631 DOI: 10.1111/dth.14825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 01/06/2021] [Accepted: 01/21/2021] [Indexed: 12/24/2022]
Abstract
Erythrodermic psoriasis (EP), which accounts for 1 to 2.25% of all psoriatic cases, typically occurs in patients with poor control of existing psoriasis. Secukinumab yields rapid and sustained improvements of signs and symptoms in patients with plaque psoriasis. Currently, clinical data on the treatment of EP with secukinumab are scarce. We describe two adult patients with severe EP, including one male and one female who were both ineligible for or resistant to acitretin or methotrexate treatment and had additional diseases. The patients underwent treatment with secukinumab using the standard regimen. After 4 weeks of treatment, a 75% reduction in the Psoriasis Area and Severity Index score (PASI 75) was achieved in both patients. Secukinumab was well tolerated and was continued for at least 32 weeks of treatment. We report the clinical use of secukinumab in the treatment of EP and review its potential role in the management of this severe condition.
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Affiliation(s)
- Luo-Chen Liu
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Xian-Hua Jin
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - ChunLei Sun
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jian-Xin Xia
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, Jilin, China
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Ma AR, Liu F, Wang R, Lin L, Wang Y, Li Q, Lu X, Du J. Prevalence of Metabolic Syndrome in Chinese Patients With Erythrodermic Psoriasis: A Case-Control Study. Front Endocrinol (Lausanne) 2021; 12:677912. [PMID: 34970217 PMCID: PMC8712334 DOI: 10.3389/fendo.2021.677912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 11/16/2021] [Indexed: 11/14/2022] Open
Abstract
Erythroderma psoriasis (EP) is a rare and severe form of psoriasis, which is a chronic inflammatory skin disease that usually occurs simultaneously with cardiovascular disease (CVD). Metabolic syndrome (MetS) is a significant precursor of CVD. This study was to investigate the association between EP and MetS in the Chinese population. We conducted a retrospective study on 86 consecutive patients with EP and 100 healthy controls from Huashan Hospital between 2013 and 2018. Demographic, biochemical parameters for MetS, and other relevant data including the severity of EP, family history of EP, age of onset, and treatment history involved in those individuals were recorded. The prevalence of MetS in erythrodermic psoriatic patients was 88.37%, which was significantly higher than that of controls (P < 0.0001). Erythrodermic psoriatic patients also had a higher prevalence of MetS components, including abdominal obesity, dyslipidemia and hypertension, whereas hyperglycemia was similar. Adjusted for confounding factors, MetS, abdominal obesity, hypertension, smoking and alcohol use were positive independent predictors of EP (odds ratio > 1, P < 0.05). The area under the receiver operating characteristic curve calculated from determined risk factors for predicting the EP's incidence was 0.934 (95% CI 0.902-0.966). There was no correlation between the severity of EP and the prevalence of MetS. Compared with patients with mild EP, patients with moderate-to-severe EP had higher body mass index, waist circumstance and blood pressure (P < 0.05). We concluded that the prevalence of MetS and its components was higher in patients with EP. MetS an independent predictor of EP, which can favor CVD and should be encouraged to correct these cardiovascular risk factors aggressively for managing EP.
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Affiliation(s)
- An-ran Ma
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Fang Liu
- Department of Dermatology, Huashan Hospital Affiliated with Fudan University, Shanghai, China
| | - Runnan Wang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Lanmei Lin
- Department of Dermatology, Huashan Hospital Affiliated with Fudan University, Shanghai, China
| | - Yilun Wang
- Department of Dermatology, Huashan Hospital Affiliated with Fudan University, Shanghai, China
| | - Qunyi Li
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaonian Lu
- Department of Dermatology, Huashan Hospital Affiliated with Fudan University, Shanghai, China
- *Correspondence: Xiaonian Lu, ; Juan Du,
| | - Juan Du
- Department of Dermatology, Huashan Hospital Affiliated with Fudan University, Shanghai, China
- *Correspondence: Xiaonian Lu, ; Juan Du,
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12
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Shao S, Wang G, Maverakis E, Gudjonsson JE. Targeted Treatment for Erythrodermic Psoriasis: Rationale and Recent Advances. Drugs 2020; 80:525-534. [PMID: 32180204 DOI: 10.1007/s40265-020-01283-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Erythrodermic psoriasis (EP) is an extreme and often refractory variant of psoriasis with high morbidity and increased mortality, and is frequently classified as a dermatological emergency. The pathophysiology of EP is largely unknown but is thought to differ from that of plaque psoriasis. Treatment of EP is challenging, and usually based on clinical experience and patient co-morbidities, due to its low incidence and limited clinical evidence. Conventional treatments, such as topical glucocorticoid therapy, cyclosporin, acitretin, and methotrexate have some but limited efficacy in EP, and treatment discontinuation may result in flares. Newer biological drugs, including anti-TNF, anti-IL-17, and anti-IL-12/23 agents, have shown promise in therapeutic management of EP, but most of the available evidence is currently based on small case series and reports. Few studies have compared available treatment options for EP, and further clinical studies are necessary to provide clinical data and optimal treatment guidelines for EP patients. Here, we provide a comprehensive review of the background of EP, assess the available clinical data on the efficacy of targeted therapies, and aim to provide a foundation for clinical decision making for this rare form of psoriasis.
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Affiliation(s)
- Shuai Shao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, 710032, China
- Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, 710032, China
| | - Emanual Maverakis
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, 95616, USA
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA.
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13
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Treatment of erythrodermic psoriasis with biologics: A systematic review. J Am Acad Dermatol 2020; 83:151-158. [DOI: 10.1016/j.jaad.2020.03.073] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 12/14/2022]
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14
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Pizzatti L, Mugheddu C, Sanna S, Atzori L, Rongioletti F. Erythrodermic psoriasis in a dialyzed patient successfully treated with Secukinumab. Dermatol Ther 2020; 33:e13348. [PMID: 32239791 DOI: 10.1111/dth.13348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/17/2020] [Accepted: 03/26/2020] [Indexed: 12/12/2022]
Abstract
Erythrodermic psoriasis is a severe, life-threatening condition with additional complications, when occurring in hemodialyzed patients, as the majority of treatments are contraindicated. A 44-years-old man, of Philippine origins, with a 15-years-history of psoriasis treated with cyclosporine developed progressive hypertension and renal insufficiency. Despite drug dismission, renal function worsen to end-stage, and hemodialysis was necessary three times a week. Phototherapy was not able to control the skin condition, progressing to erythroderma, and after nephrology consultation, the patient consent to the off-label secukinumab treatment, at the standard regimen (300 mg subcutaneously once weekly at weeks 0-4 followed by 300 mg every 4 weeks). Seven days after the first injection, a rapid improvement was noted, with the psoriasis area severity index (PASI) score passing from 31.5 to 17.6. At the 52-week-follow-up visit, the patient was completely clarified, without any side effects. The case supports secukinumab effectiveness and safety in difficult patients, including erythrodermic psoriasis with end-stage renal failure, as drug plasma levels seem not to be affected by hemodialysis. Results are rapidly achieved, and long term maintained, with the additional advantage of a very comfortable monthly administration.
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Affiliation(s)
- Laura Pizzatti
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Cristina Mugheddu
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Silvia Sanna
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Laura Atzori
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Franco Rongioletti
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Reynolds KA, Pithadia DJ, Lee EB, Liao W, Wu JJ. A systematic review of treatment strategies for erythrodermic psoriasis. J DERMATOL TREAT 2019; 32:49-55. [DOI: 10.1080/09546634.2019.1689228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | | | - Erica B. Lee
- Department of Medicine, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - Wilson Liao
- Department of Dermatology, University of San Francisco, San Francisco, CA, USA
| | - Jashin J. Wu
- Dermatology Research and Education Foundation, Irvine, CA, USA
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Menter A, Strober BE, Kaplan DH, Kivelevitch D, Prater EF, Stoff B, Armstrong AW, Connor C, Cordoro KM, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kavanaugh A, Kiselica M, Korman NJ, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Rupani RN, Siegel M, Wong EB, Wu JJ, Hariharan V, Elmets CA. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol 2019; 80:1029-1072. [PMID: 30772098 DOI: 10.1016/j.jaad.2018.11.057] [Citation(s) in RCA: 448] [Impact Index Per Article: 89.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/29/2022]
Abstract
Psoriasis is a chronic, inflammatory multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations based on the available evidence. The treatment of psoriasis with biologic agents will be reviewed, emphasizing treatment recommendations and the role of the dermatologist in monitoring and educating patients regarding benefits as well as associated risks.
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Affiliation(s)
| | - Bruce E Strober
- University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Ontario, Canada
| | | | | | | | | | | | | | - Kelly M Cordoro
- University of California, San Francisco School of Medicine, Department of Dermatology, San Francisco, California
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York
| | | | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York
| | | | | | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | | | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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Krishnamoorthy G, Kotecha A, Pimentel J. Complete resolution of erythrodermic psoriasis with first-line apremilast monotherapy. BMJ Case Rep 2019; 12:12/1/e226959. [PMID: 30709830 DOI: 10.1136/bcr-2018-226959] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Erythrodermic psoriasis (EP) is the most serious type of psoriasis with high morbidity and mortality. First-line recommended therapies for EP, cyclosporine and infliximab have significant adverse effects. Cyclosporine increases the risk of hypertension, leucopenia, infections and renal failure. Infliximab increases the risk of reactivation of tuberculosis, hepatitis B and histoplasmosis, and increases risk for hepatitis, autoantibody formation, congestive heart failure, demyelinating disorders, pancytopenia, lymphoma and skin cancer. An effective drug with a much safer side effect profile will be of significant benefit in EP. The phosphodiesterase 4 inhibitor apremilast is U.S Food and Drug Administration (FDA) approved for plaque psoriasis and psoriatic arthritis. Adverse effects of apremilast reported are headache, nausea, diarrhoea, upper respiratory tract infection, potential for depression and weight loss. We report complete and long-standing resolution of EP with first-line apremilast monotherapy. Apremilast may be an effective option with comparatively minor side effects for EP.
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Affiliation(s)
| | - Aditya Kotecha
- Pulmonary/Critical Care, Henry Ford Hospital, Detroit, Michigan, USA
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18
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Mateu-Puchades A, Santos-Alarcón S, Martorell-Calatayud A, Pujol-Marco C, Sánchez-Carazo JL. Erythrodermic psoriasis and secukinumab: Our clinical experience. Dermatol Ther 2018; 31:e12607. [PMID: 29663615 DOI: 10.1111/dth.12607] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/21/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Almudena Mateu-Puchades
- Department of Dermatology, Valencia, Dermatologist, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Sergio Santos-Alarcón
- Department of Dermatology, Valencia, Dermatologist, Hospital Universitario Doctor Peset, Valencia, Spain
| | | | - Conrad Pujol-Marco
- Department of Dermatology, Valencia, Dermatologist, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Jose-Luis Sánchez-Carazo
- Deparment of Dermatology, Valencia, Dermatologist, Consorci Hospital General Universitari de Valencia, Valencia, Spain
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19
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Kurokawa R, Hagiwara A, Niijima Y, Kojima K. Computed tomography imaging findings in erythrodermic psoriasis treated with infliximab: A case report. Radiol Case Rep 2018; 13:460-463. [PMID: 29682135 PMCID: PMC5906861 DOI: 10.1016/j.radcr.2018.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/03/2018] [Indexed: 11/25/2022] Open
Abstract
Erythrodermic psoriasis (EP), 1 of the most rare and severe forms of psoriasis, is characterized by general erythema with silvery scales. Systemic vasodilatation in EP is potentially life-threatening, however, the degree and extent of inflammation in subcutaneous tissues are difficult to estimate accurately using standard skin inspections or ultrasound examinations. Computed tomography can be a useful modality in solving this problem. The authors report a case of EP. Sequential contrast-enhanced whole-body computed tomography before and after treatment with a tumor necrosis factor-α inhibitor (infliximab) visualized the inflammation and the effect of the treatment.
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Affiliation(s)
- Ryo Kurokawa
- Department of Radiology, Toshiba Hospital, Oimachi, Tokyo, 6-3-22 Oimachi, Shinagawa-ku, Tokyo 140-8522, Japan.,Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Akifumi Hagiwara
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.,Department of Radiology, Juntendo University School of Medicine, 1-2-1, Hongo, Bunkyo-ku, Tokyo, Japan, 113-8421
| | - Yasuko Niijima
- Department of Dermatology, Toshiba Hospital, Oimachi, Tokyo, 6-3-22 Oimachi, Shinagawa-ku, Tokyo 140-8522, Japan
| | - Kaoru Kojima
- Department of Radiology, Toshiba Hospital, Oimachi, Tokyo, 6-3-22 Oimachi, Shinagawa-ku, Tokyo 140-8522, Japan
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20
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Mugheddu C, Atzori L, Lappi A, Pau M, Murgia S, Rongioletti F. Successful Secukinumab treatment of generalized pustular psoriasis and erythrodermic psoriasis. J Eur Acad Dermatol Venereol 2017; 31:e420-e421. [DOI: 10.1111/jdv.14234] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. Mugheddu
- Section of Dermatology; AOU of Cagliari - Department of Medical Science and Public Health; University of Cagliari; 09124 Cagliari Italy
| | - L. Atzori
- Section of Dermatology; AOU of Cagliari - Department of Medical Science and Public Health; University of Cagliari; 09124 Cagliari Italy
| | - A. Lappi
- Section of Dermatology; AOU of Cagliari - Department of Medical Science and Public Health; University of Cagliari; 09124 Cagliari Italy
| | - M. Pau
- Section of Dermatology; AOU of Cagliari - Department of Medical Science and Public Health; University of Cagliari; 09124 Cagliari Italy
| | - S. Murgia
- Section of Dermatology; AOU of Cagliari - Department of Medical Science and Public Health; University of Cagliari; 09124 Cagliari Italy
| | - F. Rongioletti
- Section of Dermatology; AOU of Cagliari - Department of Medical Science and Public Health; University of Cagliari; 09124 Cagliari Italy
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21
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Singh RK, Lee KM, Ucmak D, Brodsky M, Atanelov Z, Farahnik B, Abrouk M, Nakamura M, Zhu TH, Liao W. Erythrodermic psoriasis: pathophysiology and current treatment perspectives. PSORIASIS (AUCKLAND, N.Z.) 2016; 6:93-104. [PMID: 28856115 PMCID: PMC5572467 DOI: 10.2147/ptt.s101232] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Erythrodermic psoriasis (EP) is a rare and severe variant of psoriasis vulgaris, with an estimated prevalence of 1%-2.25% among psoriatic patients. The condition presents with distinct histopathologic and clinical findings, which include a generalized inflammatory erythema involving at least 75% of the body surface area. The pathogenesis of EP is not well understood; however, several studies suggest that the disease is associated with a predominantly T helper 2 (Th2) phenotype. Given the morbidity and potential mortality associated with the condition, there is a need for a better understanding of its pathophysiology. The management of EP begins with a comprehensive assessment of the patient's presentation and often requires multidisciplinary supportive measures. In 2010, the medical board of the US National Psoriasis Foundation published consensus guidelines advocating the use of cyclosporine or infliximab as first-line therapy in unstable cases, with acitretin and methotrexate reserved for more stable cases. Since the time of that publication, additional information regarding the efficacy of newer agents has emerged. We review the latest data with regard to the treatment of EP, which includes biologic therapies such as ustekinumab and ixekizumab.
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Affiliation(s)
- Rasnik K Singh
- Department of Medicine, University of California – Los Angeles, David Geffen School of Medicine, Los Angeles
| | - Kristina M Lee
- Department of Dermatology, University of California – San Francisco, San Francisco
| | - Derya Ucmak
- Department of Dermatology, University of California – San Francisco, San Francisco
| | - Merrick Brodsky
- Department of Medicine, University of California – Irvine, School of Medicine, Irvine, CA
| | - Zaza Atanelov
- Department of Medicine, New York Medical College, Valhalla, NY
| | - Benjamin Farahnik
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT
| | - Michael Abrouk
- Department of Medicine, University of California – Irvine, School of Medicine, Irvine, CA
| | - Mio Nakamura
- Department of Dermatology, University of California – San Francisco, San Francisco
| | - Tian Hao Zhu
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Wilson Liao
- Department of Dermatology, University of California – San Francisco, San Francisco
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22
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Winge MCG, Ohyama B, Dey CN, Boxer LM, Li W, Ehsani-Chimeh N, Truong AK, Wu D, Armstrong AW, Makino T, Davidson M, Starcevic D, Kislat A, Nguyen NT, Hashimoto T, Homey B, Khavari PA, Bradley M, Waterman EA, Marinkovich MP. RAC1 activation drives pathologic interactions between the epidermis and immune cells. J Clin Invest 2016; 126:2661-77. [PMID: 27294528 DOI: 10.1172/jci85738] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 04/27/2016] [Indexed: 12/17/2022] Open
Abstract
Interactions between the epidermis and the immune system govern epidermal tissue homeostasis. These epidermis-immune interactions are altered in the inflammatory disease psoriasis; however, the pathways that underlie this aberrant immune response are not well understood. Here, we determined that Ras-related C3 botulinum toxin substrate 1 (RAC1) is a key mediator of epidermal dysfunction. RAC1 activation was consistently elevated in psoriatic epidermis and primary psoriatic human keratinocytes (PHKCs) exposed to psoriasis-related stimuli, but not in skin from patients with basal or squamous cell carcinoma. Expression of a constitutively active form of RAC1 (RACV12) in mice resulted in the development of lesions similar to those of human psoriasis that required the presence of an intact immune system. RAC1V12-expressing mice and human psoriatic skin showed similar RAC1-dependent signaling as well as transcriptional overlap of differentially expressed epidermal and immune pathways. Coculture of PHKCs with immunocytes resulted in the upregulation of RAC1-dependent proinflammatory cytokines, an effect that was reproduced by overexpressing RAC1 in normal human keratinocytes. In keratinocytes, modulating RAC1 activity altered differentiation, proliferation, and inflammatory pathways, including STAT3, NFκB, and zinc finger protein 750 (ZNF750). Finally, RAC1 inhibition in xenografts composed of human PHKCs and immunocytes abolished psoriasiform hyperplasia and inflammation in vivo. These studies implicate RAC1 as a potential therapeutic target for psoriasis and as a key orchestrator of pathologic epidermis-immune interactions.
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23
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Torii H, Terui T, Matsukawa M, Takesaki K, Ohtsuki M, Nakagawa H. Safety profiles and efficacy of infliximab therapy in Japanese patients with plaque psoriasis with or without psoriatic arthritis, pustular psoriasis or psoriatic erythroderma: Results from the prospective post-marketing surveillance. J Dermatol 2015; 43:767-78. [DOI: 10.1111/1346-8138.13214] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/12/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Hideshi Torii
- Division of Dermatology; Tokyo Yamate Medical Center; Tokyo Japan
| | - Tadashi Terui
- Department of Dermatology; Nihon University School of Medicine; Tokyo Japan
| | - Miyuki Matsukawa
- Pharmacovigilance and Quality Assurance Division; Mitsubishi Tanabe Pharma Corporation; Osaka Japan
| | - Kazumi Takesaki
- Pharmacovigilance and Quality Assurance Division; Mitsubishi Tanabe Pharma Corporation; Osaka Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology; Jichi Medical University; Shimotsuke Japan
| | - Hidemi Nakagawa
- Department of Dermatology; The Jikei University School of Medicine; Tokyo Japan
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24
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Abstract
Erythrodermic psoriasis (EP) is a severe form of psoriasis that may be associated with serious and sometimes fatal complications. The treatment of EP is often a challenge, since several factors, including treatment failure or possible complications, may limit favorable outcomes with traditional drugs. Recent evidence suggests that biological drugs, including both anti-tumor necrosis factor alpha agents and ustekinumab, may be useful in improving the management of EP. Unfortunately, since subjects with EP are usually excluded from pivotal trials involving biological agents, this evidence is currently dispersed in small case series and single case reports. In this paper, we briefly analyze conventional therapies for EP, before going on to critically evaluate the existing clinical evidence for the role of current biological drugs, namely infliximab, etanercept, adalimumab, and ustekinumab. Finally, we discuss the potential benefits that newer/developmental biological agents could bring to the management of EP.
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25
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Lee WK, Kim GW, Cho HH, Kim WJ, Mun JH, Song M, Kim HS, Ko HC, Kim MB, Kim BS. Erythrodermic Psoriasis Treated with Golimumab: A Case Report. Ann Dermatol 2015; 27:446-9. [PMID: 26273164 PMCID: PMC4530158 DOI: 10.5021/ad.2015.27.4.446] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/13/2015] [Accepted: 01/16/2015] [Indexed: 01/13/2023] Open
Abstract
Erythrodermic psoriasis (EP) is a very severe variant of psoriasis whose management poses a challenge to physicians, as currently available therapies often provide unsatisfactory results. Many biologics have been used to treat chronic plaque psoriasis, the most common form of psoriasis; however, their effectiveness for EP is poorly understood. A recently developed biologic, golimumab, has been extensively studied for the treatment of moderate-to-severe active rheumatoid arthritis, psoriatic arthritis, active ankylosing spondylitis, and chronic plaque psoriasis. However, no clinical trials have been performed for EP. Here, we report the case of a 32-year-old man who presented with severe psoriasis that previously failed to respond satisfactorily to methotrexate, cyclosporine, retinoid, narrow-band ultraviolet B phototherapy, and topical agents (i.e., steroids and calcipotriol). Skin lesions worsened progressively and developed into erythroderma. Psoriatic arthritis was also detected. Conventional therapies lacked efficacy. Therefore, we administered golimumab 50 mg. The skin lesions improved significantly according to the Psoriasis Area and Severity Index score after the first administration; lesions improved further throughout the treatment course. Although additional studies are required to fully evaluate the efficacy and safety of golimumab, this agent may be an alternative treatment strategy for some patients with recalcitrant EP.
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Affiliation(s)
- Won-Ku Lee
- Department of Dermatology, Pusan National University Hospital, Busan, Korea
| | - Gun-Wook Kim
- Department of Dermatology, Pusan National University Hospital, Busan, Korea
| | - Hyun-Ho Cho
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Won-Jeong Kim
- Department of Dermatology, Pusan National University Hospital, Busan, Korea
| | - Je-Ho Mun
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Margaret Song
- Department of Dermatology, Pusan National University Hospital, Busan, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, Pusan National University Hospital, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea. ; Biomedical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, Pusan National University Hospital, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byung-Soo Kim
- Department of Dermatology, Pusan National University Hospital, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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26
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Malajian D, Guttman-Yassky E. New pathogenic and therapeutic paradigms in atopic dermatitis. Cytokine 2015; 73:311-8. [DOI: 10.1016/j.cyto.2014.11.023] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 11/14/2014] [Accepted: 11/19/2014] [Indexed: 12/15/2022]
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27
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Practical experience of ustekinumab in patients with moderate-to-severe psoriasis who had inadequate therapeutic response to previous tumor necrosis factor blockers. DERMATOL SIN 2015. [DOI: 10.1016/j.dsi.2014.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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28
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Pescitelli L, Dini V, Gisondi P, Loconsole F, Piaserico S, Piccirillo A, Stinco G, Errichetti E, Talamonti M, Tripo L, Volpi W, Prignano F. Erythrodermic psoriasis treated with ustekinumab: an Italian multicenter retrospective analysis. J Dermatol Sci 2015; 78:149-51. [PMID: 25681953 DOI: 10.1016/j.jdermsci.2015.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/21/2014] [Accepted: 01/15/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Leonardo Pescitelli
- Division of Clinical, Preventive, and Oncologic Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Valentina Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Loconsole
- Dermatology and Venereology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | | | - Giuseppe Stinco
- Institute of Dermatology, Department of Experimental and Clinical Medicine, University of Udine, Udine, Italy
| | - Enzo Errichetti
- Institute of Dermatology, Department of Experimental and Clinical Medicine, University of Udine, Udine, Italy
| | - Marina Talamonti
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Lara Tripo
- Division of Clinical, Preventive, and Oncologic Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Walter Volpi
- Division of Clinical, Preventive, and Oncologic Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Francesca Prignano
- Division of Clinical, Preventive, and Oncologic Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
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29
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Koutsoukou XA, Papadavid E, Theodoropoulos K, Rigopoulos D. Ustekinumab in severe complicated erythrodermic psoriasis: rapid clearing, safety, and sustained remission. Dermatol Ther 2014; 27:257-9. [PMID: 24813816 DOI: 10.1111/dth.12131] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Erythrodermic psoriasis is a severe type of psoriasis associated with comorbidities and high mortality. Patients with erythrodermic psoriasis need hospitalization and systemic treatment. Conventional drugs and biologic agents may not manage to control refractory and complicated erythrodermic psoriasis resulting from treatment failure. Ustekinumab, a human monoclonal antibody against interleukin-12 and 23, seems to be an effective therapeutic option in erythrodermic psoriasis whenever other therapies have failed.
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Affiliation(s)
- Xanthippe-Argyro Koutsoukou
- 2nd Department of Dermatology and Venereology, Attikon University General Hospital, University of Athens, Medical School, Athens, Greece
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30
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Abstract
PURPOSE To enhance the learner's competence with knowledge of the clinical variants and management of psoriasis. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After participating in this educational activity, the participant should be better able to:1. Demonstrate knowledge of the types, symptoms, and diagnostic testing of psoriasis.2. Apply knowledge of psoriasis treatment to patient care scenarios. ABSTRACT Psoriasis is an inflammatory skin condition that is associated with various comorbidities. To the wound care physician, the Koebner phenomenon is of importance, as any superficial trauma can induce psoriasis. Particularly, periwound and joints are particularly susceptible to flare-ups of this condition. This review highlights the epidemiology and treatment of psoriasis.
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31
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Infliximab treatment of psoriasis in supervised infusion centers: case management experience. Am J Clin Dermatol 2014; 15 Suppl 1:S17-24. [PMID: 24777572 DOI: 10.1007/s40257-013-0055-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Psoriasis is a systemic chronic inflammatory disease that affects 1-3% of the world's population. Knowledge of the pathogenesis of psoriasis, particularly in the understanding of the role of T cells and tumor necrosis factor α (TNFα), and advances in immunology have led to the development of biological agents, which, due to their great effectiveness, speed of response and good tolerability, have revolutionized patient management. One of these is infliximab, a human chimeric immunoglobulin G1 monoclonal antibody composed of human antibody constant regions and murine variable regions that was developed specifically to target TNFα. The six cases presented in this series highlight the feasibility, efficacy and safety of infliximab for psoriasis when administered in a variety of patients in several infusion centers across Spain. All six patients showed improvement in their psoriasis after the initiation of infliximab and no significant tolerability issues or injection site reactions were reported, despite the presence of several comorbid conditions or patient characteristics that traditionally reduce the efficacy of psoriasis treatments. This suggests that while the management of psoriasis patients with comorbid conditions and various unfavorable prognostic characteristics requires a multidisciplinary approach to ensure the patient obtains the best therapeutic response, infliximab is an effective and well tolerated treatment in these patients.
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32
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Dunst-Huemer KM, Scheurecker C, Auboeck J. Generalized erythroderma and palmoplantar hyperkeratosis in a patient receiving TNF-alpha antagonist therapy. J Cutan Pathol 2013; 40:855-6. [DOI: 10.1111/cup.12188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 06/01/2013] [Accepted: 06/08/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Josef Auboeck
- Department of Dermatology and Venerology; General Hospital Linz; Linz; Austria
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33
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Gyöngyösi N, Lőrincz K, Kárpáti S, Wikonkál N. Development of lupus erythematosus during infliximab treatment. Orv Hetil 2013; 154:590-8. [DOI: 10.1556/oh.2013.29588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Infliximab is a TNFα inhibiting recombinant monoclonal antibody, which provides an efficient therapeutic opportunity in the treatment of psoriasis and other immune-mediated inflammatory diseases. It is well tolerated and improves quality of life significantly. The authors present a case of drug-induced lupus erythematosus as a possible side effect of this medication. The patient developed psoriasis 9 years ago when she was on beta-receptor blocker therapy. The symptoms deteriorated despite topical and systemic treatments and, therefore, biological therapy was introduced. In the third year of treatment drug-induced lupus erythematosus was diagnosed on the background of general symptoms. After cessation of the biologic treatment a low dose corticosteroid therapy was introduced which proved to be effective. Symptoms as well as pathological laboratory parameters showed an improvement. The authors conclude that biologicals are effective and safe in the treatment of psoriasis, nevertheless, they have risks too. To reduce side effects a meticulous follow-up of patients is essential. Any general symptom requires careful examination since they might be linked to serious side effects of the biological therapy. Orv. Hetil., 2013, 154, 590–598.
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Affiliation(s)
- Nóra Gyöngyösi
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Kende Lőrincz
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Sarolta Kárpáti
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Norbert Wikonkál
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
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34
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Abstract
INTRODUCTION Atopic dermatitis (AD) is a common inflammatory skin disease regulated by genetic and environmental factors. Both skin barrier defects and aberrant immune responses are believed to drive cutaneous inflammation in AD. Existing therapies rely largely on allergen avoidance, emollients and topical and systemic immune-suppressants, some with significant toxicity and transient efficacy; no specific targeted therapies are in clinical use today. As our specific understanding of the immune and molecular pathways that cause different subsets of AD increases, a variety of experimental agents, particularly biologic agents that target pathogenic molecules bring the promise of safe and effective therapeutics for long-term use. AREAS COVERED This paper discusses the molecular pathways characterizing AD, the contributions of barrier and immune abnormalities to its pathogenesis, and development of new treatments that target key molecules in these pathways. In this review, we will discuss a variety of biologic therapies that are in development or in clinical trials for AD, perhaps revolutionizing treatment of this disease. EXPERT OPINION Biologic agents in moderate to severe AD offer promise for controlling a disease that currently lacks good and safe therapeutics posing a large unmet need. Unfortunately, existing treatments for AD aim to decrease cutaneous inflammation, but are not specific for the pathways driving this disease. An increasing understanding of the immune mechanisms underlying AD brings the promise of narrow targeted therapies as has occurred for psoriasis, another inflammatory skin disease, for which specific biologic agents have been demonstrated to both control the disease and prevent occurrence of new skin lesions. Although no biologic is yet approved for AD, these are exciting times for active therapeutic development in AD that might lead to revolutionary therapeutics for this disease.
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Affiliation(s)
- Emma Guttman-Yassky
- The Rockefeller University, Laboratory for Investigative Dermatology, New York, NY, USA
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