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López E, Cabrera R, Lecaros C. Targeted therapy for immune mediated skin diseases. What should a dermatologist know? An Bras Dermatol 2024; 99:546-567. [PMID: 38521706 DOI: 10.1016/j.abd.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/25/2023] [Accepted: 10/14/2023] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Molecularly targeted therapies, such as monoclonal antibodies (mAbs) and Janus Kinase inhibitors (JAKis), have emerged as essential tools in the treatment of dermatological diseases. These therapies modulate the immune system through specific signaling pathways, providing effective alternatives to traditional systemic immunosuppressive agents. This review aims to provide an updated summary of targeted immune therapies for inflammatory skin diseases, considering their pathophysiology, efficacy, dosage, and safety profiles. METHODS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search was conducted on PubMed over the past 10 years, focusing on randomized clinical trials, case reports, and case series related to targeted immune therapies in dermatology. Eligibility criteria were applied, and data were extracted from each study, including citation data, study design, and results. RESULTS We identified 1360 non-duplicate articles with the initial search strategy. Title and abstract review excluded 1150, while a full-text review excluded an additional 50 articles. The review included 143 studies published between 2012 and 2022, highlighting 39 drugs currently under investigation or in use for managing inflammatory skin diseases. STUDY LIMITATIONS The heterogeneity of summarized information limits this review. Some recommendations originated from data from clinical trials, while others relied on retrospective analyses and small case series. Recommendations will likely be updated as new results emerge. CONCLUSION Targeted therapies have revolutionized the treatment of chronic skin diseases, offering new options for patients unresponsive to standard treatments. Paradoxical reactions are rarely observed. Further studies are needed to fully understand the mechanisms and nature of these therapies. Overall, targeted immune therapies in dermatology represent a promising development, significantly improving the quality of life for patients with chronic inflammatory skin diseases.
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Affiliation(s)
- Edinson López
- Department of Dermatology, Facultad de Medicina Universidad del Desarrollo-Clínica Alemana de Santiago, Santiago, Chile
| | - Raúl Cabrera
- Department of Dermatology, Facultad de Medicina Universidad del Desarrollo-Clínica Alemana de Santiago, Santiago, Chile.
| | - Cristóbal Lecaros
- Department of Dermatology, Facultad de Medicina Universidad del Desarrollo-Clínica Alemana de Santiago, Santiago, Chile
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Wride AM, Chen GF, Spaulding SL, Tkachenko E, Cohen JM. Biologics for Psoriasis. Dermatol Clin 2024; 42:339-355. [PMID: 38796266 DOI: 10.1016/j.det.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
Biologic therapies targeting tumor necrosis factor alpha (TNF-α) (infliximab, adalimumab, certolizumab, etanercept), the p40 subunit shared by IL-12 and IL-23 (ustekinumab), the p19 subunit of IL-23 (guselkumab, tildrakizumab, risankizumab), IL-17A (secukinumab, ixekizumab), IL-17-RA (brodalumab) and both IL-17A and IL-17F (bimekizumab) have revolutionized the treatment of psoriasis. In both the short and long term, risankizumab had highest Psoriasis Area and Severity Index 90 scores compared to other oral and injectable biologics. IL-23 inhibitors had lowest rates of short-term and long-term adverse events and most favorable long-term risk-benefit profile compared to IL-17, IL-12/23, and TNF-α inhibitors.
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Affiliation(s)
- Anthony Mitchel Wride
- Department of Dermatology, Yale School of Medicine, Yale University, 15 York Street, New Haven, CT 06510, USA
| | - Gloria F Chen
- Department of Dermatology, Yale School of Medicine, Yale University, 15 York Street, New Haven, CT 06510, USA
| | - Sarah L Spaulding
- Department of Dermatology, Yale School of Medicine, Yale University, 15 York Street, New Haven, CT 06510, USA
| | - Elizabeth Tkachenko
- Department of Dermatology, Yale School of Medicine, Yale University, 15 York Street, New Haven, CT 06510, USA
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, Yale University, 15 York Street, New Haven, CT 06510, USA.
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Magdaleno-Tapial J, Torrijos Aguilar A, González-Delgado V, Hernández-Bel P. Dupilumab to Treat Chronic Palmoplantar Eczema: A Retrospective Multicenter Cohort Study. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:628-631. [PMID: 38373606 DOI: 10.1016/j.ad.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 02/21/2024] Open
Affiliation(s)
- J Magdaleno-Tapial
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España.
| | - A Torrijos Aguilar
- Servicio de Dermatología, Hospital Arnau de Vilanova de Valencia, Valencia, España
| | - V González-Delgado
- Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - P Hernández-Bel
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España
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Magdaleno-Tapial J, Torrijos Aguilar A, González-Delgado V, Hernández-Bel P. [Translated article] Dupilumab to Treat Chronic Palmoplantar Eczema: A Retrospective Multicenter Cohort Study. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T628-T631. [PMID: 38653369 DOI: 10.1016/j.ad.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/04/2023] [Indexed: 04/25/2024] Open
Affiliation(s)
- J Magdaleno-Tapial
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, Spain.
| | - A Torrijos Aguilar
- Servicio de Dermatología, Hospital Arnau de Vilanova de Valencia, Valencia, Spain
| | - V González-Delgado
- Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - P Hernández-Bel
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, Spain
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5
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Zhao SS, Yiu ZZN. Genetically proxied IL-6 receptor inhibition is associated with increased risk of atopic dermatitis. J Allergy Clin Immunol 2024:S0091-6749(24)00554-2. [PMID: 38801923 DOI: 10.1016/j.jaci.2024.05.016] [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: 12/15/2023] [Revised: 04/08/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Dermatitis has been reported after initiation of IL-6 receptor (IL-6R) inhibitors (IL-6Ri), while genetic association studies of atopic dermatitis (AD) have implicated IL-6R pathway signaling. However, causality remains unclear. As the indications for IL-6Ri expand, so do the clinical importance of determining whether there is mechanistic evidence linking it to AD. OBJECTIVE Our aim was to examine the association between IL-6Ri and risk of AD. METHODS To genetically mimic IL-6Ri, we selected single-nucleotide polymorphisms within or near the IL6R gene associated with C-reactive protein at genome-wide significance among 343,524 individuals. Genetic data were obtained from 10,788 individuals with AD and 30,047 controls of European ancestry. We used inverse variance-weighted and pleiotropy-robust methods and examined genetic confounding using colocalization. Analyses were replicated by using 13,473 Finnish and 2,385 East Asian individuals with AD. The results from 3 independent analyses were pooled by meta-analysis. RESULTS Genetically proxied IL-6Ri was associated with increased risk of AD (odds ratio [OR] = 1.78 per 4.4-mg/L reduction in C-reactive protein level [95% CI = 1.28-2.48] [P = 6.5 × 10-4]). The results were replicated using Finnish outcome data (OR = 2.07 [95% CI = 1.58-2.72] [P = 1.57 × 10-7]) and Eastern Asian data (OR = 1.68 [95% CI = 1.12-2.54] [P = .013]). Meta-analysis of 3 independent populations (OR = 1.89 [95% CI = 1.57-2.28] [P = 2.68 × 10-11]) showed no evidence of heterogeneity (P = .65). We found no statistical evidence for pleiotropy or genetic confounding. CONCLUSION This genetic investigation provides consistent evidence (across independent multiancestry populations) that IL-6R signaling is causally implicated in AD susceptibility. Clinicians should remain vigilant for adverse effects resembling AD when using IL-6R inhibitors for immune-mediated inflammatory diseases.
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Affiliation(s)
- Sizheng Steven Zhao
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biological Medicine and Health, The University of Manchester, Manchester, United Kingdom.
| | - Zenas Z N Yiu
- Dermatology Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Ch’en PY, Al-Saedy M, Song EJ. Upadacitinib as a treatment for co-existent allergic contact dermatitis and psoriasis. JAAD Case Rep 2024; 44:20-22. [PMID: 38292580 PMCID: PMC10824681 DOI: 10.1016/j.jdcr.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
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7
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Kim JE, Lee J, Huh YJ, Kim K, Chaparala V, Krueger JG, Kim J. Genomic Profiling of the Overlap Phenotype between Psoriasis and Atopic Dermatitis. J Invest Dermatol 2024; 144:43-52.e6. [PMID: 37419444 PMCID: PMC11060321 DOI: 10.1016/j.jid.2023.06.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 07/09/2023]
Abstract
Clinical overlaps between psoriasis and atopic dermatitis (AD) are sometimes undiscernible, and there is no consensus on whether to treat the overlap phenotype as psoriasis or AD. We enrolled 41 patients diagnosed with either psoriasis or AD and clinically re-stratified them into classic psoriasis (n = 11), classic AD (n = 13), and the overlap phenotype between psoriasis and AD (n = 17). We compared the gene expression profiles of lesional and nonlesional skin biopsy tissues and the proteomic profiles of blood samples among the three comparison groups. Global mRNA expression and T-cell subset cytokine expression in the skin and protein biomarker elevation in the blood of the overlap phenotype were consistent with the profiles of psoriasis and different from the profiles of AD. Unsupervised k-means clustering indicated that the best number of distinct clusters for the total population of the three comparison groups was two, and the two clusters of psoriasis and AD were differentiated by gene expression. Our study suggests that the clinical overlap phenotype between psoriasis and AD has dominant molecular features of psoriasis, and genomic biomarkers can differentiate psoriasis and AD at molecular levels in patients with a spectrum of psoriasis and AD.
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Affiliation(s)
- Jeong Eun Kim
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Republic of Korea; Bio-Bigdata Research Center, Hanyang Insitute of Bioscience and Biotechnology, Hanyang University, Seoul, Republic of Korea
| | - Jongmi Lee
- Dermatology Section, Veterans Affairs Northern California Health Care System, Mather, California, USA
| | - Yun Jung Huh
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Katherine Kim
- Dermatology Section, Veterans Affairs Northern California Health Care System, Mather, California, USA
| | - Vasuma Chaparala
- Dermatology Section, Veterans Affairs Northern California Health Care System, Mather, California, USA
| | - James G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Jaehwan Kim
- Dermatology Section, Veterans Affairs Northern California Health Care System, Mather, California, USA; Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA; Department of Dermatology, University of California Davis, Sacramento, California, USA.
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8
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Müller S, Welchowski T, Schmid M, Maintz L, Herrmann N, Wilsmann-Theis D, Royeck T, Havenith R, Bieber T. Development of a clinical algorithm to predict phenotypic switches between atopic dermatitis and psoriasis (the "Flip-Flop" phenomenon). Allergy 2024; 79:164-173. [PMID: 37864390 DOI: 10.1111/all.15921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/17/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) and psoriasis vulgaris (PV) are almost mutually exclusive diseases with different immune polarizations, mechanisms and therapeutic targets. Switches to the other disease ("Flip-Flop" [FF] phenomenon) can occur with or without systemic treatment and are often referred to as paradoxical reactions under biological therapy. METHODS The objective was to develop a diagnostic algorithm by combining clinical criteria of AD and PV to identify FF patients. The algorithm was prospectively validated in patients enrolled in the CK-CARE registry in Bonn, Germany. Afterward, algorithm refinements were implemented based on machine learning. RESULTS Three hundred adult Caucasian patients were included in the validation study (n = 238 with AD, n = 49 with PV, n = 13 with FF; mean age 41.2 years; n = 161 [53.7%] female). The total FF scores of the PV and AD groups differed significantly from the FF group in the validation data (p < .001). The predictive mean generalized Youden-Index of the initial model was 78.9% [95% confidence interval 72.0%-85.6%] and the accuracy was 89.7%. Disease group-specific sensitivity was 100% (FF), 95.0% (AD), and 61.2% (PV). The specificity was 89.2% (FF), 100% (AD), and 100% (PV), respectively. CONCLUSION The FF algorithm represents the first validated tool to identify FF patients.
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Affiliation(s)
- Svenja Müller
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
- Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
| | - Thomas Welchowski
- Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Laura Maintz
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
- Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
| | - Nadine Herrmann
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
- Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
| | | | - Thorben Royeck
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
| | - Regina Havenith
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
- Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
- Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
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Zhou J, Yuan Y, Liu Y, Chu M, Liu H, Liu Q, Wang R, Shao S, Wang G, Yu C. Effectiveness and safety of secukinumab in Chinese patients with moderate to severe plaque psoriasis in real-world practice. Exp Dermatol 2024; 33:e14890. [PMID: 37474877 DOI: 10.1111/exd.14890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/19/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023]
Abstract
A number of randomized controlled trials and real-world studies have demonstrated the effectiveness and safety of secukinumab in the treatment of moderate to severe psoriasis, whereas data on a large cohort of Chinese patients in long-term real-world practice are limited. This was a single-centre, uncontrolled, single-arm, prospective, observational cohort study that included 254 psoriatic patients treated with secukinumab between September 2019 and December 2022. Demographic and clinical characteristics of patients, clinical response and adverse events were evaluated. The 75% improvement in Psoriasis Area and Severity Index score (PASI 75), PASI 90, and PASI 100 in the 300 mg secukinumab group at 12 weeks were 91.7%, 74.0% and 39.7% respectively, increasing to 94.5%, 74.5% and 47.6% at 52 weeks. High body mass index (BMI), previous exposure to biologic therapies and history of previous conventional systemic therapies were associated with lower rates of PASI response. During the study period, 68 patients reported 83 adverse events (AEs) and the most frequent AEs were eczematous lesions. Up to 14.5% patients withdrew treatment due to disease remission combined with inconvenient transportation during the COVID-19 pandemic at 52 weeks. The rate of psoriasis exacerbation after COVID-19 infection in patients treated with secukinumab was 24.3% (17/70). This real-world study confirmed the high effectiveness of secukinumab in Chinese patients with moderate to severe plaque psoriasis, with an acceptable safety profile.
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Affiliation(s)
- Jian Zhou
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, P. R. China
| | - Yuan Yuan
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, P. R. China
| | - Yanhua Liu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, P. R. China
| | - Mengyang Chu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, P. R. China
| | - Huan Liu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, P. R. China
| | - Qian Liu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, P. R. China
| | - Rui Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, P. R. China
| | - Shuai Shao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, P. R. China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, P. R. China
| | - Chen Yu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, P. R. China
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Li Q, Li X, Li W, Fan R, Ma Q, Luo X, Jian H, Chen X, Cao C, Zheng W. Development of IL-17A inhibitor-induced atopic dermatitis-like rash in psoriasis patients: Insights into immune shift. Exp Dermatol 2024; 33:e14958. [PMID: 38009235 DOI: 10.1111/exd.14958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 11/28/2023]
Abstract
Cases of atopic dermatitis (AD)-like rash induced by IL-17A inhibitor secukinumab treatment (SI-AD) have been recently reported in psoriasis patients. To identify immune and inflammatory factors expression in SI-AD. A panel of 15 immune and inflammatory factors in peripheral blood samples from various groups, including patients with patients with SI-AD, psoriasis with secukinumab (S-stable), advanced psoriasis patients (Advanced) and healthy controls (HC). Interleukin-10 (IL-10), IL-4 and IL-17A were detected in skin tissue biopsy samples by immunohistochemistry and real-time quantitative polymerase chain reaction. The immunoglobulin E levels in the SI-AD patients exceeded normal values. The IL-10 levels in SI-AD patients were higher than those in S-stable patients, advanced patients and HC. The IL-4 levels in SI-AD patients were higher than that in S-stable patients and HC. The IL-17A levels in SI-AD patients were higher than those in advanced psoriasis patients and HC, but no significant differences were observed between SI-AD patients and S-stable patients. IL-10 and IL-4 levels were higher in AD-like rashes than in healthy skin, while IL-17A did not differ significantly between the two. Upon discontinuing secukinumab, and switching to oral cyclosporine, antihistamines, Janus kinase 1 inhibitor and topical glucocorticoids, SI-AD patients experienced significant improvement in their skin lesions. Upon reexamination, all 15 immune and inflammatory factors returned to normal levels. Immune shift from Th17 towards Th2 may occur in SI-AD, as indicated by abnormal expression of multiple immune and inflammatory factors observed in peripheral blood and skin tissues.
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Affiliation(s)
- Qiuju Li
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiuying Li
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wenyu Li
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Runge Fan
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qing Ma
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaomei Luo
- Department of Dermatology and Venereology, Baise People's Hospital, Baise, China
| | - Huahui Jian
- Department of Dermatology and Venereology, Baise People's Hospital, Baise, China
| | - Xiaozhi Chen
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Cunwei Cao
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wenjun Zheng
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Tang X, Li Q, Zhou Y, Zheng X, Zhou C, Hu Y, Wang P, Chen A, Huang K. Predictive factors of atopic-like dermatitis induced by IL-17A inhibitors in patients with psoriasis: A 2-year follow-up study. J Eur Acad Dermatol Venereol 2023; 37:2509-2516. [PMID: 37528440 DOI: 10.1111/jdv.19394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Atopic-like dermatitis (ALD) is a common side effect of interleukin-17A (IL-17A) inhibitors. OBJECTIVE To determine the prevalence, risk factors, outcomes and treatment of ALD in a cohort of psoriasis patients treated with IL-17A inhibitors. METHODS This retrospective study included 226 psoriasis patients treated with an IL-17A inhibitor in our dermatology department between July 2020 and July 2022. The patients were reviewed over 2 years. A logistic regression model in rare events data (relogit) was used to predict the risk factors for ALD. RESULTS Of the 226 patients, 14 had ALD. Data including age, body mass index, IL-17A inhibitor use, personal and family history of atopic disease, pet ownership history, and immunoglobulin E (IgE) levels were analysed using the relogit regression model. It indicated a personal history of atopic disease (odd ratio [OR] 27.830, 95% confidence interval [CI] 3.801-203.770; p = 0.001) and elevated IgE levels (OR 5.867, 95% CI 1.131-30.434; p = 0.035) as independent predictors of incident ALD. In one patient, anti-IL-17A therapy was discontinued, and treatment was switched to tofacitinib. Thirteen patients who continued with IL-17A inhibitor were treated with topical therapy and/or antihistamines, and their ALD was partially or completely resolved. CONCLUSION In this study, the incidence rate of ALD was 6.19%. Elevated IgE levels and a personal history of atopic disease were found to be the risk factors for ALD. Our study findings suggest that treatment should be provided based on the severity of psoriasis and incident ALD. Prior to treatment, psoriasis patients who have the risk factors for ALD should be informed of the possible development of ALD, and alternative psoriatic therapeutic options should be considered if severe ALD develops.
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Affiliation(s)
- Xin Tang
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Li
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Zhou
- College of Traditional Chinese Medicine of Chongqing Medical University, Chongqing, China
| | - Xuyu Zheng
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Cui Zhou
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yulian Hu
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Wang
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Aijun Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kun Huang
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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12
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Luan L, Lv C. RETRACTED ARTICLE: Secukinumab-induced paradoxical skin lesions, but successful treatment with tofacitinib in SAPHO syndrome: a case report. J DERMATOL TREAT 2023; 34:2193662. [PMID: 36940237 DOI: 10.1080/09546634.2023.2193662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/13/2023] [Indexed: 03/21/2023]
Abstract
We, the Editors and Publisher of Journal of Dermatological Treatment, have retracted the following article:Li Luan & Chengzhi Lv (2023) Secukinumab-induced paradoxical skin lesions, but successful treatment with tofacitinib in SAPHO syndrome: a case report, Journal of Dermatological Treatment, DOI: 10.1080/09546634.2023.2193662Since publication of the article, concerns were raised by a reader regarding the lack of recorded patient consent to publish. Upon further investigation, it was determined that written consent for the publication was not obtained by the authors. The authors were contacted for an explanation and confirmed written consent for the publication was not obtained.As this represents a breach of the journal's editorial policies, we are therefore retracting the article. The corresponding author listed in this publication has been informed.We have been informed in our decision-making by our editorial policies and the COPE guidelines.The retraction article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as 'Retracted'.
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Affiliation(s)
- Li Luan
- Department of Dermatology and Venereology, the affiliated zhongshanhospital of DaLian University
| | - Chengzhi Lv
- Department of Dermatology and Venereology, dermatology hospital of DaLian
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13
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Eyerich S, Eyerich K. Iatrogenic switch from psoriasis to eczema: What does it mean and is it predictable? J Eur Acad Dermatol Venereol 2023; 37:2401-2402. [PMID: 38011664 DOI: 10.1111/jdv.19561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Stefanie Eyerich
- ZAUM - Center of Allergy and Environment, Technical University and Helmholtz Center Munich, Munich, Germany
| | - Kilian Eyerich
- Department of Dermatology and Venerology, Medical Center, University of Freiburg, Freiburg, Germany
- Division of Dermatology and Venerology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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14
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Balakirski G, Burmann SN, Hofmann SC, Kreuter A. Paradoxical tralokinumab-induced psoriasis in a patient with atopic dermatitis. J DERMATOL TREAT 2023; 34:2258240. [PMID: 37705378 DOI: 10.1080/09546634.2023.2258240] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/08/2023] [Indexed: 09/15/2023]
Abstract
Purpose: Although psoriasis and atopic dermatitis (AD) were for decades considered to be opposing diseases, it is now known that these skin conditions can coexist or even overlap in the same individual. Especially when using modern drugs with targeted IL inhibition, the balance between Th1 and Th2 immunity can be disturbed. In line with it, numerous clinical cases of AD have been induced by antipsoriatic biologics (e.g., TNF-alpha, IL-23, or IL-17 inhibitors), and IL-4-/IL-13 inhibition by dupilumab also resulted in paradoxical psoriasis in patients with AD.Materials and methods: Herein, we describe a case of psoriasis vulgaris in a patient with intrinsic AD after systemic treatment with the anti-IL-13 antibody tralokinumab.Results: We present a 36-years-old male patient with a severe course of an intrinsic atopic dermatitis and dyshidrotic hand eczema. He responded well to the therapy with tralokinumab. However, about 7 months after the start of anti-IL-13 treatment the patient developed psoriasiform lesions. The drug was then discontinued. Currently, the patient is receiving topical therapy with topical corticosteroids and calcineurin inhibitors with stable course of psoriasis and AD.Conclusions: This case suggests, that not only a dual IL-4-/IL-13-blockade, but also a selective IL-13-inhibition is able to skew immune responses toward IL-17 cytokine pathway-related disease. However, no clinical scores exist to predict the development of paradoxical psoriasis in patients with AD during therapy with biologics.
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Affiliation(s)
- Galina Balakirski
- Center for Dermatology, Allergology and Dermatosurgery, Helios University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
| | - Sven-Niklas Burmann
- Department of Dermatology, Venereology and Allergology, Helios St. Elisabeth Hospital Oberhausen, University of Witten/Herdecke, Oberhausen, Germany
| | - Silke C Hofmann
- Center for Dermatology, Allergology and Dermatosurgery, Helios University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
| | - Alexander Kreuter
- Department of Dermatology, Venereology and Allergology, Helios St. Elisabeth Hospital Oberhausen, University of Witten/Herdecke, Oberhausen, Germany
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15
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Al-Janabi A, Martin P, Khan AR, Foulkes AC, Smith CH, Griffiths CEM, Morris AP, Eyre S, Warren RB. Integrated proteomics and genomics analysis of paradoxical eczema in psoriasis patients treated with biologics. J Allergy Clin Immunol 2023; 152:1237-1246. [PMID: 37536512 DOI: 10.1016/j.jaci.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/10/2023] [Accepted: 07/21/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Few studies have explored the immunology and genetic risk of paradoxical eczema occurring as an adverse event of biologic therapy in patients with psoriasis. OBJECTIVES We sought to describe the systemic inflammatory signature of paradoxical eczema using proteomics and explore whether this is genetically mediated. METHODS This study used the Olink Target 96 Inflammation panel on 256 serum samples from 71 patients with psoriasis and paradoxical eczema, and 75 controls with psoriasis to identify differentially expressed proteins and enriched gene sets. Case samples from 1 or more time points (T1 prebiologic, T2 postbiologic, and T3 postparadoxical eczema) were matched 1:1 with control samples. Genes contributing to enriched gene sets were selected, and functional single nucleotide polymorphisms used to create polygenic risk scores in a genotyped cohort of 88 paradoxical eczema cases and 3124 psoriasis controls. RESULTS STAMBP expression was lower in cases at T1 than in controls (log-fold change: -0.44; adjusted P = .022); no other proteins reached statistical significance at equivalent time points. Eleven gene sets including cytokine and chemokine pathways were enriched in cases at T2 and 10 at T3. Of the 39 proteins contributing to enriched gene sets, the majority are associated with the atopic dermatitis serum proteome. A polygenic risk score including 38 functional single nucleotide polymorphisms linked to enriched gene sets was associated with paradoxical eczema (adjusted P = .046). CONCLUSIONS The paradoxical eczema systemic inflammatory proteome trends toward atopic dermatitis at a gene-set level and is detectable before onset of the phenotype. This signature could be genetically determined.
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Affiliation(s)
- Ali Al-Janabi
- Centre for Dermatology Research, Northern Care Alliance NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom.
| | - Paul Martin
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, United Kingdom; The Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | | | - Amy C Foulkes
- Centre for Dermatology Research, Northern Care Alliance NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Catherine H Smith
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom; St. John's Institute of Dermatology, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Christopher E M Griffiths
- Centre for Dermatology Research, Northern Care Alliance NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Andrew P Morris
- Centre for Dermatology Research, Northern Care Alliance NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom; Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, United Kingdom
| | - Steve Eyre
- Centre for Dermatology Research, Northern Care Alliance NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom; Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, United Kingdom
| | - Richard B Warren
- Centre for Dermatology Research, Northern Care Alliance NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
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16
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Desai SR, Stein Gold L, Cameron MC, Golant A, Lewitt GM, Bruno MJ, Martin G, Brown PM, Rubenstein DS, Butners V, Tallman AM. Tapinarof Cream 1% Once Daily for the Treatment of Plaque Psoriasis: Case Photography of Clinical Outcomes from Three Phase 3 Trials. Dermatol Ther (Heidelb) 2023; 13:2443-2460. [PMID: 37697121 PMCID: PMC10539260 DOI: 10.1007/s13555-023-01008-9] [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: 07/04/2023] [Accepted: 08/07/2023] [Indexed: 09/13/2023] Open
Abstract
Tapinarof cream 1% (VTAMA®; Dermavant Sciences, Inc.) is a non-steroidal, topical, aryl hydrocarbon receptor agonist approved by the US Food and Drug Administration (FDA) to treat plaque psoriasis in adults and under investigation for the treatment of psoriasis in children down to 2 years of age, and for atopic dermatitis in adults and children down to 2 years of age. The PSOARING phase 3 clinical trial program evaluated tapinarof cream 1% once daily (QD) in adults with mild to severe plaque psoriasis for up to 52 weeks (NCT03956355, NCT03983980, NCT04053387). Here we present case photography documenting outcomes in the PSOARING trials. Cases illustrate various outcomes across different body areas, including responses meeting the formal FDA-mandated regulatory endpoint of a Physician Global Assessment (PGA) score of 0 (clear) or 1 (almost clear) and a decrease of at least 2 points from baseline at week 12, meaningful clinical improvement not meeting this formal endpoint, patient-reported outcomes, and pre-specified adverse events of special interest (AESIs). Tapinarof cream 1% QD demonstrated rapid and highly statistically significant efficacy, with improvements in disease activity and quality of life. In addition, a high rate (40.9%; n = 312/763) of complete disease clearance (PGA = 0) was achieved, and improvements exceeding National Psoriasis Foundation treatment goals were demonstrated. After first achieving complete disease clearance (PGA = 0), patients treated with tapinarof experienced an approximately 4-month remittive effect off therapy. Incidence and severity of folliculitis and contact dermatitis AESIs were generally mild or moderate, localized to the site of application, and associated with low discontinuation rates. Medical images are of importance in trials of dermatologic therapies to inform clinical decision-making and enhance patient assessment. Tapinarof cream 1% QD is efficacious and well tolerated in patients with mild to severe plaque psoriasis, with clinically relevant improvements seen early in the course of treatment.Clinicaltrials.gov numbers: NCT03956355, NCT03983980, NCT04053387.
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Affiliation(s)
- Seemal R Desai
- Department of Dermatology, The University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd 4th Floor, Suite 100, Dallas, TX, USA.
- Innovative Dermatology, Plano, TX, USA.
| | | | - Michael C Cameron
- Cameron Dermatology, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - George Martin
- George Martin Dermatology Associates, Kihei, HI, USA
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17
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Bieber T. Disease modification in inflammatory skin disorders: opportunities and challenges. Nat Rev Drug Discov 2023; 22:662-680. [PMID: 37443275 DOI: 10.1038/s41573-023-00735-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/15/2023]
Abstract
Progress in understanding of the mechanisms underlying chronic inflammatory skin disorders, such as atopic dermatitis and psoriasis vulgaris, has led to new treatment options with the primary goal of alleviating symptoms. In addition, this knowledge has the potential to inform on new strategies aimed at inducing deep and therapy-free remission, that is, disease modification, potentially impacting on associated comorbidities. However, to reach this goal, key areas require further exploration, including the definitions of disease modification and disease activity index, further understanding of disease mechanisms and systemic spillover effects, potential windows of opportunity, biomarkers for patient stratification and successful intervention, as well as appropriate study design. This Perspective article assesses the opportunities and challenges in the discovery and development of disease-modifying therapies for chronic inflammatory skin disorders.
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Affiliation(s)
- Thomas Bieber
- Department of Dermatology and Allergy, University Hospital, Bonn, Germany.
- Christine Kühne - Center for Allergy Research and Education, Davos, Switzerland.
- Davos Biosciences, Davos, Switzerland.
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18
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Al-Janabi A, Eyre S, Foulkes AC, Khan AR, Dand N, Burova E, DeSilva B, Makrygeorgou A, Davies E, Smith CH, Griffiths CEM, Morris AP, Warren RB. Atopic Polygenic Risk Score Is Associated with Paradoxical Eczema Developing in Patients with Psoriasis Treated with Biologics. J Invest Dermatol 2023; 143:1470-1478.e1. [PMID: 36804406 DOI: 10.1016/j.jid.2023.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 02/17/2023]
Abstract
Biologic therapies for psoriasis can cause paradoxical eczema. The role of genetic factors in its pathogenesis is unknown. To identify risk variants, we conducted a GWAS of 3,212 patients with psoriasis, of whom 88 developed paradoxical eczema. Two lead SNPs reached genome-wide significance (P ≤ 5 × 10-8) for association with paradoxical eczema: rs192705221 (near UNC5B, P = 9.52 × 10-10) and rs72925168 (within SLC1A2, P = 1.66 × 10-9). Genome-wide significant SNPs from published GWAS were used to generate polygenic risk scores (PRSs) for atopic eczema, general atopic disease, or a combination, which were tested for association with paradoxical eczema. Improvement over a clinical risk model was assessed by the area under the curve. All three atopy polygenic risk scores were associated with paradoxical eczema (P < 0.05); polygenic risk score for a combination of atopic eczema and general atopic disease had the strongest association (OR = 1.83, 95% CI = 1.17-2.84, P = 0.0078). Including atopic polygenic risk scores in the multivariable model, which included age, sex, atopic background, and psoriatic arthritis history, increased the area under the curve from 0.671 to 0.681-0.686. Atopic genetic burden is associated with paradoxical eczema occurring in biologic-treated patients with psoriasis, indicating shared underlying mechanisms. Incorporating genetic risk may improve treatment outcome prediction models for psoriasis.
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Affiliation(s)
- Ali Al-Janabi
- Centre for Dermatology Research, Salford Royal NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, United Kingdom.
| | - Steve Eyre
- Centre for Dermatology Research, Salford Royal NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, United Kingdom; Centre for Genetics & Genomics Versus Arthritis, The University of Manchester, Manchester, United Kingdom; Centre for Musculoskeletal Research, The University of Manchester, Manchester, United Kingdom
| | - Amy C Foulkes
- Centre for Dermatology Research, Salford Royal NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, United Kingdom
| | | | - Nick Dand
- Department of Medical & Molecular Genetics, Faculty of Life Sciences and Medicine, School of Basic & Medical Biosciences, King's College London, London, United Kingdom
| | - Ekaterina Burova
- Dermatology, Bedfordshire Hospitals NHS Trust, Bedford, United Kingdom
| | - Bernadette DeSilva
- Department of Dermatology, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Areti Makrygeorgou
- Dermatology Department, West Ambulatory Care Hospital, Glasgow, United Kingdom
| | - Emily Davies
- Department of Dermatology, Gloucester Royal Hospital, Gloucester, United Kingdom
| | - Catherine H Smith
- St. John's Institute of Dermatology, Faculty of Life Sciences and Medicine, School of Basic and Medical Biosciences, King's College London, London, United Kingdom; St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Christopher E M Griffiths
- Centre for Dermatology Research, Salford Royal NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, United Kingdom
| | - Andrew P Morris
- Centre for Genetics & Genomics Versus Arthritis, The University of Manchester, Manchester, United Kingdom; Centre for Musculoskeletal Research, The University of Manchester, Manchester, United Kingdom
| | - Richard B Warren
- Centre for Dermatology Research, Salford Royal NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, United Kingdom
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19
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Zhou Q, Zhou S, Xiong H, Yang J, Yang Z, Zhou N, Mao J, Li M. A Case of Paradoxical Reactions to Biologic Therapy for Psoriasis. Clin Cosmet Investig Dermatol 2023; 16:1493-1497. [PMID: 37333515 PMCID: PMC10275371 DOI: 10.2147/ccid.s412520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023]
Abstract
Introduction Psoriasis is an immune-mediated chronic inflammatory skin disease. As our understanding of the pathogenesis of psoriasis has improved, biologic agents have become increasingly important in the treatment of psoriasis. However, the use of biologic agents is associated with cutaneous side effects. A new type of side effect called paradoxical reactions is an emerging threat arising from the increasing use of biologic agents. Case Here, we present a case of paradoxical skin reactions - pyoderma gangrenosum (PG) and eczema - induced by biologic therapy. The case was successfully and eventually treated with baricitinib. Discussion PG is a rare inflammatory disease characterised by painful and necrotic ulcerations containing neutrophils. It has been associated with autoimmune diseases such as inflammatory bowel disease (IBD). TNF (tumor necrosis factor) -α inhibitors can effectively treat refractory PG, while IL (interleukin) -17A inhibitors may worsen IBD symptoms. The cause of PG in this case was believed to be secukinumab, not adalimumab. The patient was diagnosed with eczematous dermatitis due to TNF-α inhibitors, and baricitinib was added to treat eczematous dermatitis. Conclusion Paradoxical reactions are unpredictable events that may occur during treatment with biologics at anytime. They need further research in order to formulate personalised treatment.
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Affiliation(s)
- Qianqian Zhou
- Department of Dermatology, Dushu Lake Hospital Affiliated to Soochow University (Medical Center of Soochow University, Suzhou Dushu Lake Hospital), Suzhou, People’s Republic of China
| | - Shengru Zhou
- Department of Dermatology, Dushu Lake Hospital Affiliated to Soochow University (Medical Center of Soochow University, Suzhou Dushu Lake Hospital), Suzhou, People’s Republic of China
| | - Huizi Xiong
- Department of Dermatology, Dushu Lake Hospital Affiliated to Soochow University (Medical Center of Soochow University, Suzhou Dushu Lake Hospital), Suzhou, People’s Republic of China
| | - Jianqiu Yang
- Department of Dermatology, Dushu Lake Hospital Affiliated to Soochow University (Medical Center of Soochow University, Suzhou Dushu Lake Hospital), Suzhou, People’s Republic of China
| | - Ziliang Yang
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Naihui Zhou
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Jinzhu Mao
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Min Li
- Department of Dermatology, Dushu Lake Hospital Affiliated to Soochow University (Medical Center of Soochow University, Suzhou Dushu Lake Hospital), Suzhou, People’s Republic of China
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
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20
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Xiao Y, Peng S, Li X, Mao T, Fang M, Hu Y, Ye W. Treatment of paradoxical eczematous eruption in psoriasis treated with secukinumab: A case report. Medicine (Baltimore) 2023; 102:e32844. [PMID: 36820537 PMCID: PMC9907985 DOI: 10.1097/md.0000000000032844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
RATIONALE Eczematous eruption is an increasingly recognized form of drug-related eruption, typically reported in association with interleukin 17 (IL-17)A inhibitors. However, severe paradoxical eczematous eruption due to IL-17A inhibitors has been rarely reported. Herein, we reported a case of a man with severe psoriasis with erythematous scaly plaques on the scalp, trunk, and arms and legs after the administration of secukinumab was initiated. PATIENT CONCERNS We reported a case of a 20-year-old man with severe psoriasis with erythematous scaly plaques on the scalp, trunk, and arms and legs after the administration of secukinumab was initiated. A skin biopsy was performed. It revealed spongiotic dermatitis consistent with eczematous reaction. Direct and indirect immunofluorescence assays were negative. DIAGNOSES He was diagnosed with eczematous eruption. INTERVENTIONS Discontinuation of secukinumab and administration of cyclosporine and prednisone were considered. OUTCOMES Significant improvement was observed, with no adverse events. CONCLUSION Our case shows that eczematous eruption can paradoxically occur in patients on IL-17A inhibitors and this report is expected to increase awareness of the rising number of cutaneous eruptions related to biological agents.
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Affiliation(s)
- Yu Xiao
- The Central Hospital of Xiaogan, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Hubei, China
| | - Shanshan Peng
- The Central Hospital of Xiaogan, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Hubei, China
| | - Xiangjun Li
- The Central Hospital of Xiaogan, Jinzhou Medical University, Hubei, China
| | - Tianyi Mao
- The Central Hospital of Xiaogan, Jinzhou Medical University, Hubei, China
| | - Muping Fang
- The Central Hospital of Xiaogan, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Hubei, China
| | - Youhong Hu
- The Central Hospital of Xiaogan, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Hubei, China
| | - Wenzheng Ye
- The Central Hospital of Xiaogan, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Hubei, China
- * Correspondence: Wenzheng Ye, The Central Hospital of Xiaogan, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Hubei 432000, China (e-mail: )
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21
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Minai L, Takeichi T, Ogawa Y, Honobe-Tabuchi A, Okamoto T, Mitsui H, Shimada S, Akiyama M, Kawamura T. Development of pemphigus vegetans and exacerbation of pemphigus foliaceus after secukinumab loading in a patient with complicated generalized pustular psoriasis and pyoderma gangrenosum. J Dermatol 2023; 50:245-249. [PMID: 36052669 DOI: 10.1111/1346-8138.16563] [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: 06/03/2022] [Revised: 07/30/2022] [Accepted: 08/15/2022] [Indexed: 02/04/2023]
Abstract
In dermatology, biologics that block signaling pathways of TNF-α, IL-4/IL13, IL-17s, and IL-23 are widely used for the treatment of several inflammatory skin diseases, such as atopic dermatitis and psoriasis. They have shown excellent efficacy with an acceptable safety profile. However, these biologics targeting pathogenic cytokines and their receptors could modulate immunological balance, leading to the development of other inflammatory or autoimmune skin diseases in some cases. In this study, we present a patient who suffered pemphigus vegetans and showed an exacerbation of pemphigus foliaceus after secukinumab loading for the treatment of complicated generalized pustular psoriasis and pyoderma gangrenosum.
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Affiliation(s)
- Lisa Minai
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Takuya Takeichi
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Youichi Ogawa
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Akiko Honobe-Tabuchi
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Takashi Okamoto
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Hiroshi Mitsui
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Shinji Shimada
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Masashi Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tatsuyoshi Kawamura
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
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22
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DE Luca E, Caldarola G, DI Stefani A, D'Amore A, Sfregola S, DE Simone C. A case of eczematous eruption occurring during treatment with risankizumab. Ital J Dermatol Venerol 2023; 158:64-65. [PMID: 36939506 DOI: 10.23736/s2784-8671.22.07360-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Affiliation(s)
- Eleonora DE Luca
- Institute of Dermatology, Sacred Heart Catholic University, Rome, Italy
- Department of Dermatology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Giacomo Caldarola
- Institute of Dermatology, Sacred Heart Catholic University, Rome, Italy -
- Department of Dermatology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Alessandro DI Stefani
- Institute of Dermatology, Sacred Heart Catholic University, Rome, Italy
- Department of Dermatology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Alessandra D'Amore
- Institute of Dermatology, Sacred Heart Catholic University, Rome, Italy
- Department of Dermatology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Stefania Sfregola
- Section of Anatomic Pathology, Department of Life Sciences and Public Health, Sacred Heart Catholic University, Rome, Italy
- Unit of Anatomic Pathology, Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Clara DE Simone
- Institute of Dermatology, Sacred Heart Catholic University, Rome, Italy
- Department of Dermatology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
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23
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Hattori N, Koike Y, Murota H. Skin microbiome analysis in a case of atopic dermatitis induced by an interleukin 17 inhibitor used to treat psoriasis. J Dermatol 2023; 50:104-106. [PMID: 36117474 DOI: 10.1111/1346-8138.16586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/22/2022] [Accepted: 09/05/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Naoko Hattori
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuta Koike
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroyuki Murota
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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24
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Maurelli M, Gisondi P, Girolomoni G. Tailored biological treatment for patients with moderate-to-severe psoriasis. Expert Rev Clin Immunol 2023; 19:37-43. [PMID: 36300752 DOI: 10.1080/1744666x.2023.2141226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Psoriasis is a common, chronic immune-mediated skin disease frequently associated to inflammatory and metabolic comorbidities. About 20-30% of patients are affected by moderate-to-severe psoriasis and require a systemic treatment, which include traditional and biological drugs. The objective of this manuscript is to provide criteria for a personalized biological treatment. AREAS COVERED Tailoring a biological treatment for patients with moderate-to-severe psoriasis needs to consider several variables related to the disease, the patient and the treatment. It is important to consider the disease severity and activity, the skin areas involved, the frequency of relapses, itch or other symptoms, and foremost the presence of comorbidities. About the patient, is important to consider age, gender, body weight, the occupation, the impact on the quality of life, the likelihood of adherence, patient expectations, the desire for remission, and the fear of side effects. EXPERT OPINION The presence of comorbidities, which may benefit from or contraindicate a given biologic, is the main driver of a tailored therapy. A personalized treatment associates maximum efficacy and minimal risk of side effects. In addition, there is the possibility of modifying disease-course inducing long-term remission and preventing the development of psoriatic arthritis.
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Affiliation(s)
- Martina Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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25
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Shi L, Liu C, Xiong H, Shi D. Elevation of IgE in patients with psoriasis: Is it a paradoxical phenomenon? Front Med (Lausanne) 2022; 9:1007892. [PMID: 36314037 PMCID: PMC9606585 DOI: 10.3389/fmed.2022.1007892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/26/2022] [Indexed: 11/25/2022] Open
Abstract
Immunoglobulin E (IgE) elevation is a hallmark of allergic conditions such as atopic dermatitis (AD). The pathogenesis of AD is typically associated with high levels of IL-4 and IL-13 produced by activated T helper 2 (Th2) cells. Psoriasis, on the other hand, is an inflammatory skin disease mainly driven by Th17 cells and their related cytokines. Although the immunopathologic reactions and clinical manifestations are often easily distinguished in the two skin conditions, patients with psoriasis may sometimes exhibit AD-like manifestations, such as elevated IgE and persistent pruritic lesions. Given the fact that the effective T cells have great plasticity to re-differentiate in response to innate and environmental factors, this unusual skin condition could be a consequence of a cross-reaction between distinct arms of T-cell and humoral immunity. Here we review the literature concerning the roles of IgE in the development of AD and psoriasis, showing that elevated IgE seems to be an important indicator for this non-typical psoriasis.
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Affiliation(s)
- Leyao Shi
- The Second Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China,The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China
| | - Chen Liu
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China
| | - Huabao Xiong
- Basic Medical School, Institute of Immunology and Molecular Medicine, Jining Medical University, Jining, China,Huabao Xiong
| | - Dongmei Shi
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China,Department of Dermatology, Jining No.1 People's Hospital, Jining, China,*Correspondence: Dongmei Shi
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Dolinger MT, Rolfes P, Spencer E, Stoffels G, Dunkin D, Dubinsky MC. Outcomes of Children with Inflammatory Bowel Disease who Develop Anti-tumour Necrosis Factor-induced Skin Reactions. J Crohns Colitis 2022; 16:1420-1427. [PMID: 35390140 DOI: 10.1093/ecco-jcc/jjac055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/14/2022] [Accepted: 04/01/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Anti-tumour necrosis factor [anti-TNF] induced skin reactions are common adverse events in paediatric inflammatory bowel disease [IBD]. We aimed to report on outcomes of children with anti-TNF induced skin reactions who switched to ustekinumab [UST] vs. continued anti-TNF therapy. METHODS Charts were reviewed for paediatric IBD patients with anti-TNF induced skin reactions. Skin reactions, including psoriasiform dermatitis [PD], were classified as mild or severe based on a severity score. Primary outcome was frequency of skin resolution at 6 months. Secondary outcomes were combined clinical remission and skin resolution at 6 months and skin resolution at latest follow-up. RESULTS A total of 111/638 [17%] children ([85, 21%] infliximab [IFX]; [26, 11%] adalimumab [ADA]) developed skin reactions. Eighty [72%] had PD, 25 [23%] infections, and four [4%] alopecia areata; 71 [64%] continued anti-TNF; and 40 [36%] switched to UST. In all, 73 [66%] had severe reactions and were more likely to switch to UST than if mild (37 [51%] vs. 3 [8%]; p <0.0001). Switching to UST had a higher rate and odds of resolution (29 [73%] vs. 24 [34%]; p <0.0001; odds ratio [OR] = 19.7, 95% confidence interval [CI]: 5.6, 69.5; p <0.0001) and combined remission (21 [52%] vs. 22 [31%]; p = 0.03; OR = 8.5, 95% CI: 2.5, 28.4; p = 0.0005] vs. continuing anti-TNF at 6 months. CONCLUSIONS Children who switched to UST after anti-TNF induced skin reactions were more likely to have improved outcomes than those who continued anti-TNF therapy. Future studies are needed to determine immune mechanisms of anti-TNF induced skin reactions and treatment response.
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Affiliation(s)
- Michael T Dolinger
- Department of Pediatric Gastroenterology, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Priya Rolfes
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth Spencer
- Department of Pediatric Gastroenterology, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Guillaume Stoffels
- Department of Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Dunkin
- Department of Pediatric Gastroenterology, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marla C Dubinsky
- Department of Pediatric Gastroenterology, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Miyagawa F. Pathogenesis of Paradoxical Reactions Associated with Targeted Biologic Agents for Inflammatory Skin Diseases. Biomedicines 2022; 10:biomedicines10071485. [PMID: 35884790 PMCID: PMC9312477 DOI: 10.3390/biomedicines10071485] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022] Open
Abstract
Targeted biologic agents have dramatically changed the therapeutic landscape for immune-mediated inflammatory diseases, particularly in rheumatology and dermatology. Their introduction has resulted in a paradigm shift, i.e., they produce significant clinical improvements in most patients with such diseases. Nevertheless, a variety of adverse reactions associated with these agents have been observed, including so-called paradoxical reactions (PRs), which are a new class of adverse events. PRs involve the de novo development or worsening of immune-mediated inflammatory disease during treatment with a targeted biologic agent that is commonly used to treat the idiopathic counterpart of the drug-induced reaction. In addition, the efficacy of biologic agents targeting individual cytokines and the existence of PRs to them have provided proof that cytokines are key drivers of various immune-mediated inflammatory diseases and helped researchers elucidate the molecular pathways underlying the pathophysiology of these diseases. Here, a comprehensive review of the targeted biologic agents used to treat immune-mediated inflammatory diseases, particularly psoriasis and atopic dermatitis, is provided, with a specific focus on biologic agents that inhibit cytokine signaling involving tumor necrosis factor-α, interleukin (IL)-12/23 (p40), IL-17A (and the IL-17 receptor [R]), IL-23 (p19), and the IL-4Rα, and their associated PRs. The characteristic clinical manifestations and potential immunological mechanisms of the PRs induced by these biologic agents are also reviewed.
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Affiliation(s)
- Fumi Miyagawa
- Department of Dermatology, Nara Medical University School of Medicine, Nara 634-8522, Japan
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28
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Messina F, Piaserico S. The dark side of the moon: the immune-mediated adverse events of IL-17A/IL-17R inhibition. J DERMATOL TREAT 2022; 33:2443-2454. [PMID: 35393910 DOI: 10.1080/09546634.2022.2062281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
As aberrant IL-17 signaling plays a critical role in the pathogenesis of psoriasis, biologic agents targeting this pathway have become an important weapon against this disease. Some biologic agents such as IL-17 inhibitors (secukinumab and ixekizumab) and the IL-17 receptor (IL17R) inhibitor (brodalumab) are relatively safe, tolerable and efficacious drugs. Nevertheless, side effects of IL-17 pathway inhibition occur. This review focuses on the dermatological manifestations linked to these treatments. Paradoxical psoriasis and atopic-like eczema may be the most common cutaneous adverse events, while manifestations such as neutrophilic dermatoses, hypersensitivity reactions, lichenoid eruptions, vasculitides, bullous diseases, lupus-like reactions, pigmentation disorders, adnexal diseases and granulomatous dermatoses have been described less frequently.
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Affiliation(s)
- Francesco Messina
- Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy
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29
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Th2 IL-4/IL-13 dual blockade with Dupilumab is linked to some Emergent Th17 type Diseases including seronegative arthritis, enthesitis/enthesopathy, but not humoral autoimmune diseases. J Invest Dermatol 2022; 142:2660-2667. [PMID: 35395222 DOI: 10.1016/j.jid.2022.03.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/02/2022] [Accepted: 03/18/2022] [Indexed: 01/17/2023]
Abstract
Dupilumab, an IL-4/IL-13 receptor blocker, has been linked to emergent seronegative inflammatory arthritis and psoriasis that form part of the spondyloarthropathy (SpA) spectrum. We systematically investigated patterns of immune disorders including predominantly Th17- (SpA pattern), Th2-mediated disorders and humoral autoimmune pattern diseases, using VigiBase, the World Health Organization's (WHO) global pharmacovigilance of adverse drug reactions (ADRs). Several bioinformatics databases and repositories were mined to couple Dupilumab-related immune-pharmacovigilance with molecular cascades relevant to reported findings. 37,848 Dupilumab ADR cases were reported, with skin, eye, musculoskeletal systems most affected. Seronegative arthritis (OR 9.61) psoriasis (OR 1.48), enthesitis/enthesopathy (OR 12.65), and iridocyclitis (OR 3.77) were highly associated. However, Ankylosing Spondylitis and IBD were not conclusively associated. Overall, classic polygenic humorally-mediated autoimmune diseases such as RA and SLE were not associated with Dupilumab use. Pathway analysis identified several biological pathways potentially involved in Dupilumab-associated ADRs, including the fibroblast growth factor receptor (FGFR; in particular, FGFR2) pathway. miRNAs analysis revealed the potential involvement of hsa-miR-21-5p and hsa-miR-335-5p. In conclusion, IL-4/IL-13 blockers are not unexpectedly protective against humoral autoimmune diseases but dynamically skew immune responses towards some IL-23/IL-17 cytokine pathway-related diseases. A robust signal potentially towards degenerative related pathology in the eye and vasculature due to loss of IL-4/IL-13 tissue reparative homeostatic mechanisms emerged.
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30
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Al-Janabi A, Foulkes AC, Griffiths CEM, Warren RB. Paradoxical eczema in psoriasis patients receiving biologics: a case series. Clin Exp Dermatol 2022; 47:1174-1178. [PMID: 35150003 PMCID: PMC9310746 DOI: 10.1111/ced.15130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 12/01/2022]
Abstract
Atopic eczema and psoriasis are chronic, inflammatory dermatoses that can significantly affect the quality of life of those affected. Although both diseases are common, they rarely occur together. Severe psoriasis can be treated with biologic therapies targeting specific cytokine pathways involved in disease pathogenesis. There are reports of paradoxical eczema developing in biologic-treated psoriasis patients, sometimes necessitating treatment discontinuation leading to poor disease control. This retrospective case series identified 36 such events occurring in 23 patients. All currently-available biologic classes were implicated. Eosinophilia (n=19) and elevated serum immunoglobulin-E (n=3) were identified in some cases. Treatment strategies included no treatment, topical corticosteroids, broad-acting systemic agents and discontinuation or switch of biologic therapy. Two patients had persistent eczema and psoriasis despite discontinuation of all biologic therapies.
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Affiliation(s)
- Ali Al-Janabi
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, The University of Manchester, M6 8HD, UK
| | - Amy C Foulkes
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, The University of Manchester, M6 8HD, UK
| | - Christopher E M Griffiths
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, The University of Manchester, M6 8HD, UK
| | - Richard B Warren
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, The University of Manchester, M6 8HD, UK
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31
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Sánchez-Velázquez A, Falkenhain-López D, López-Valle A, Rodríguez Peralto J, Ortiz Romero P, Rivera-Díaz R. Eczematous reactions induced by anti-IL17 agents: Report of two cases and possible pathogenic mechanisms. Indian J Dermatol 2022; 67:307-308. [DOI: 10.4103/ijd.ijd_448_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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32
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Al-Janabi A, Yiu ZZN. Biologics in Psoriasis: Updated Perspectives on Long-Term Safety and Risk Management. Psoriasis (Auckl) 2022; 12:1-14. [PMID: 35024352 PMCID: PMC8747772 DOI: 10.2147/ptt.s328575] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/23/2021] [Indexed: 12/12/2022] Open
Abstract
Biologics targeting Th1/Th17 cytokines have revolutionised psoriasis treatment. In addition to treatment effectiveness, it is important to define and understand the long-term risks of biologic therapy in order to guide therapy selection and minimise these risks for patients where possible. This review article summarises available evidence from trial data, observational studies and pharmacovigilance registries to explore key long-term risks of biologic treatment, and how these risks might be managed in clinical practice.
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Affiliation(s)
- A Al-Janabi
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, M6 8HD, UK
| | - Z Z N Yiu
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, M6 8HD, UK
- Correspondence: ZZN Yiu Dermatology Centre, Salford Royal Hospital, Stott Lane, Manchester, M6 8HD, UK Email
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33
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Miller J, Puravath AP, Orbai AM. Ixekizumab for Psoriatic Arthritis: Safety, Efficacy, and Patient Selection. J Inflamm Res 2021; 14:6975-6991. [PMID: 34949934 PMCID: PMC8691193 DOI: 10.2147/jir.s229752] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/04/2021] [Indexed: 12/15/2022] Open
Abstract
Objective Ixekizumab is a monoclonal antibody targeting IL-17A and licensed for psoriasis, psoriatic arthritis (PsA) and axial spondyloarthritis. Review objectives were to summarize: 1) ixekizumab safety in people with PsA, 2) ixekizumab efficacy from Phase III randomized controlled trials, and 3) ixekizumab study participant PsA phenotypes. Methods We conducted a search in PubMed limited to phase III randomized controlled trials (RCT) and corresponding long-term extension studies where the intervention was treatment with ixekizumab in a population with PsA. Results We identified 17 publications and 13 met inclusion criteria. Injection site reactions (ISR) and allergic reactions occurred in up to 25.3% and 6.2% with ixekizumab and 4.5% and 1.85, respectively, with placebo. ISR occurred in 9.5-10.6% at 24 and 52 weeks with ixekizumab versus 3.2-3.5% with adalimumab (p < 0.01) in biologic-naïve PsA. Serious adverse events at 24 weeks occurred in 8.5% with adalimumab versus 3.5% with ixekizumab (p = 0.02), and at 52 weeks in 12.45 with adalimumab and 4.25 with ixekizumab (p < 0.01). Ixekizumab had similar efficacy to adalimumab across all PsA musculoskeletal, symptom and patient-reported outcome domains and surpassed adalimumab in psoriasis outcomes as well as all combined musculoskeletal and psoriasis outcomes. The study subject population was overwhelmingly white, balanced men-women, BMI at the obese threshold, had on average 7-year PsA duration and 15-year psoriasis duration. Disease activity was high with 7/66 swollen joints, 13/68 tender joints, 55% enthesitis, variable dactylitis (12-51%), and active psoriasis in >92%. Conclusion Ixekizumab treatment in PsA was associated with a statistically significant higher risk of injection site reactions versus placebo or adalimumab. Ixekizumab had statistically significantly fewer serious adverse events than adalimumab. Ixekizumab demonstrated efficacy for all PsA disease activity domains as well as for slowing radiographic disease progression. The main shortcoming of the ixekizumab PsA program is lack of representation of African American study participants.
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Affiliation(s)
- John Miller
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Lyme Disease Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Abin P Puravath
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ana-Maria Orbai
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Psoriatic Arthritis Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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34
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Bridgewood C, Newton D, Bragazzi N, Wittmann M, McGonagle D. Unexpected connections of the IL-23/IL-17 and IL-4/IL-13 cytokine axes in inflammatory arthritis and enthesitis. Semin Immunol 2021; 58:101520. [PMID: 34799224 DOI: 10.1016/j.smim.2021.101520] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/03/2021] [Indexed: 12/14/2022]
Abstract
The IL-23/IL-17 cytokine axis is related to spondyloarthropathy (SpA) pattern diseases that target the skin, eye, gut and joints. These share overlapping target tissues with Th2 type or allergic diseases, including the skin, eye and gut but SpA diseases exhibit distinct microanatomical topography, molecular characteristics, and clinical features including uveitis, psoriasis, apical pulmonary involvement, lower gastrointestinal involvement with colitis, and related arthritides including psoriatic arthritis and ankylosing spondylitis. Inflammatory arthritis is conspicuously absent from the Th2 diseases which are characterised IL-4/IL-13 dependent pathway activation including allergic rhino-conjunctivitis, atopic eczema, allergic asthma and food allergies. This traditional understanding of non-overlap of musculoskeletal territory between that atopic diseases and the IL-17 -mediated SpA diseases is undergoing a critical reappraisal with the recent demonstration of IL-4/IL-13 blockade, may be associated with the development of SpA pattern arthritis, psoriasiform skin disease and occasional anterior uveitis. Given the known plasticity within Th paradigm pathways, these findings suggest dynamic Th2 cytokine and Th17 cytokine counter regulation in vivo in humans. Unexpected, this is the case in peripheral enthesis and when the IL-4/13 immunological brake on IL-23/17 cytokines is removed, a SpA phenotype may emerge. We discuss hitherto unexpected observations in SpA, showing counter regulation between the Th17 and Th2 pathways at sites including the entheses that collectively indicate that the emergent reverse translational therapeutic data is more than coincidental and offers new insights into the "Th paradigms" in atopy and SpA.
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Affiliation(s)
- Charlie Bridgewood
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.
| | - Darren Newton
- Division of Haematology and Immunology, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Nicola Bragazzi
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
| | - Miriam Wittmann
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals, Leeds, UK
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals, Leeds, UK
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35
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Nakazawa S, Honda T. Plantar pustules in a psoriasis patient during the guselkumab therapy. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2021. [DOI: 10.1002/cia2.12176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Shinsuke Nakazawa
- Department of Dermatology Hamamatsu University School of Medicine Shizuoka Japan
| | - Tetsuya Honda
- Department of Dermatology Hamamatsu University School of Medicine Shizuoka Japan
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36
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Niebel D, Novak N, Wilhelmi J, Ziob J, Wilsmann-Theis D, Bieber T, Wenzel J, Braegelmann C. Cutaneous Adverse Reactions to COVID-19 Vaccines: Insights from an Immuno-Dermatological Perspective. Vaccines (Basel) 2021; 9:944. [PMID: 34579181 PMCID: PMC8470727 DOI: 10.3390/vaccines9090944] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023] Open
Abstract
(1) Background: Numerous vaccines are under preclinical and clinical development for prevention of severe course and lethal outcome of coronavirus disease 2019 (COVID-19). In light of high efficacy rates and satisfactory safety profiles, some agents have already reached approval and are now distributed worldwide, with varying availability. Real-world data on cutaneous adverse drug reactions (ADRs) remain limited. (2) Methods: We performed a literature research concerning cutaneous ADRs to different COVID-19 vaccines, and incorporated our own experiences. (3) Results: Injection site reactions are the most frequent side effects arising from all vaccine types. Moreover, delayed cutaneous ADRs may occur after several days, either as a primary manifestation or as a flare of a pre-existing inflammatory dermatosis. Cutaneous ADRs may be divided according to their cytokine profile, based on the preponderance of specific T-cell subsets (i.e., Th1, Th2, Th17/22, Tregs). Specific cutaneous ADRs mimic immunogenic reactions to the natural infection with SARS-CoV-2, which is associated with an abundance of type I interferons. (4) Conclusions: Further studies are required in order to determine the best suitable vaccine type for individual groups of patients, including patients suffering from chronic inflammatory dermatoses.
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Affiliation(s)
- Dennis Niebel
- Department of Dermatology and Allergy, University Hospital Bonn, 53127 Bonn, Germany; (N.N.); (J.W.); (J.Z.); (D.W.-T.); (T.B.); (J.W.); (C.B.)
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37
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Miyagawa F, Fukuda K, Mori A, Ogawa K, Asada H. Recurrence of secukinumab-induced eczematous eruptions after guselkumab treatment for pustular psoriasis. J Dermatol 2021; 48:E498-E499. [PMID: 34212414 DOI: 10.1111/1346-8138.16047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Fumi Miyagawa
- Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Keiko Fukuda
- Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Asuka Mori
- Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Kohei Ogawa
- Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Hideo Asada
- Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Japan
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38
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Schäbitz A, Eyerich K, Garzorz-Stark N. So close, and yet so far away: The dichotomy of the specific immune response and inflammation in psoriasis and atopic dermatitis. J Intern Med 2021; 290:27-39. [PMID: 33428274 DOI: 10.1111/joim.13235] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/13/2020] [Accepted: 12/09/2020] [Indexed: 12/11/2022]
Abstract
Characterization of the complex interplay between cytokines, chemokines and microorganisms has led to a better understanding of the pathogenesis of both psoriasis and AD and resulted in new therapeutics targeting distinct immune responses. Psoriasis and AD share many characteristics: they are highly prevalent, chronic, cause primarily skin inflammation, but are associated with comorbidities, and come with a devastating quality of life due to itch and stigmatization. However, the pathogenesis of psoriasis and AD is opposing - psoriasis is dominated by a Th17 immune response that causes neutrophil migration, induction of innate immunity and exaggerated epithelial metabolism. Leading cytokines of this Th17 immune response are IL-17A and F, IL-22 and TNF-a. AD is characterized by Th2 immunity characterized by the signature cytokines IL-4 and IL-13 leading to an impaired epidermal barrier, dampened innate immunity and eosinophil migration. This review compares genetics, microbiome and T-cell infiltrate and resulting epithelial response in psoriasis and AD. Whilst the antagonistic course of psoriasis and AD is confirmed by response to specific biologics targeting the key cytokines of inflammation in psoriasis and AD, respectively, clinically overlapping phenotypes are challenging in our daily clinical practice. We conclude this review by summarizing what is known about these mixed phenotypes and how the identification of clinically relevant endotypes and molecular-driven decision-making is the next step in the field of dermato-immunology.
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Affiliation(s)
- A Schäbitz
- From the, Division of Dermatology and Venereology, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - K Eyerich
- From the, Division of Dermatology and Venereology, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Dermatology and Venereology, Unit of Dermatology, Karolinska University Hospital, Stockholm, Sweden.,Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - N Garzorz-Stark
- From the, Division of Dermatology and Venereology, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
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Peera M, Smith A. Palmoplantar pompholyx secondary to interleukin 17A inhibitor therapy for psoriasis: A case series. JAAD Case Rep 2021; 13:46-48. [PMID: 34141846 PMCID: PMC8188176 DOI: 10.1016/j.jdcr.2021.03.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Melissa Peera
- Department of Dermatology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Annika Smith
- Department of Dermatology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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40
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Brunner PM, Conrad C, Vender R, Grond S, Schuster C, Patel H, Xu W, Carrascosa Carrillo JM. Integrated safety analysis of treatment-emergent eczematous reactions in patients with moderate-to-severe psoriasis treated with ixekizumab, etanercept and ustekinumab. Br J Dermatol 2021; 185:865-867. [PMID: 34076896 PMCID: PMC8518506 DOI: 10.1111/bjd.20527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/06/2021] [Accepted: 05/30/2021] [Indexed: 01/18/2023]
Affiliation(s)
- P M Brunner
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C Conrad
- Department of Dermatology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - R Vender
- Dermatrials Research Inc, Hamilton, ON, Canada
| | - S Grond
- Eli Lilly and Company, Indianapolis, IN, USA
| | - C Schuster
- Department of Dermatology, Medical University of Vienna, Vienna, Austria.,Eli Lilly and Company, Indianapolis, IN, USA
| | - H Patel
- Eli Lilly and Company, Indianapolis, IN, USA
| | - W Xu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - J M Carrascosa Carrillo
- Department of Dermatology, Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
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Abstract
Eczematous drug eruptions are a heterogenous group of skin reactions that resemble eczema both clinically and histologically. We reviewed the literature and cataloged the systemically administered medications that cause these eruptions, along with their characteristic clinical presentations. We identified three primary pathophysiologic etiologies: (1) cutaneous immunomodulation, (2) skin dehydration, and (3) delayed hypersensitivity. Notably, eczematous eruptions caused by altered immunity in the skin may be increasing in incidence as some responsible drugs, in particular biologic therapies (such as tumor necrosis factor-α and interleukin-17 inhibitors) and targeted cancer treatments (including immune checkpoint inhibitors and epidermal growth factor receptor inhibitors), become more commonly employed in clinical practice. Other notable causes of eczematous eruptions include antiviral agents for hepatitis C virus and cardiovascular medications in elderly individuals, and notable subtypes of eczematous reactions include systemic contact dermatitis and photoallergic reactions, which are also discussed. The diagnostic gold standard is drug rechallenge and most reactions may be treated effectively with emollients, topical corticosteroids, and oral antihistamines.
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Affiliation(s)
| | - Susan Burgin
- Harvard Medical School, Boston, MA, USA.
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA.
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42
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Yamanaka K, Yamamoto O, Honda T. Pathophysiology of psoriasis: A review. J Dermatol 2021; 48:722-731. [PMID: 33886133 DOI: 10.1111/1346-8138.15913] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/31/2022]
Abstract
Psoriasis is a complex chronic inflammatory skin disease caused by the dynamic interplay between multiple genetic risk foci, environmental risk factors, and excessive immunological abnormalities. Psoriasis affects approximately 2% of the population worldwide, and dramatic advances have been achieved in the understanding and treatment options for psoriasis. Recent progress in biological therapies has revealed the fundamental roles of tumor necrosis factor-α, interleukin (IL)-23p19, and the IL-17A axis together with skin-resident immune cells and major signal transduction pathways in the pathogenesis of psoriasis. In addition to IL-17-producing T helper17 cells, innate lymphoid cell (ILC)3 induces psoriasis rashes directly without T-cell/antigen interaction in response to the released antimicrobial peptides from activated keratinocytes and inflammatory cytokines. ILC3 typically expresses retinoic acid receptor-related orphan receptor gamma t in the nucleus, matures in the presence of IL-7 and IL-23, and produces IL-17 and IL-22. The number of ILC3s is increased in the blood, psoriasis rash, and even in nonrash areas of psoriatic skin. Psoriasis is significantly associated with cardiovascular disease, metabolic syndrome, and inflammatory disorders, particularly the severe type. The similarity of enterobacteria in the psoriasis gut to that in diabetic patients may be related to its pathogenesis. In the current review, we focus on the pathophysiology of psoriasis in the accelerated immunological inflammatory loop, danger signal from keratinocytes, and cytokines, particularly IL-17 and IL-23p19. In addition, pathophysiological speculation with regard to morphology has been supplemented. Finally, the differences and similarities between psoriasis and atopic dermatitis are discussed.
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Affiliation(s)
- Keiichi Yamanaka
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Osamu Yamamoto
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Tetsuya Honda
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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43
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Cutaneous Manifestations in Biological-Treated Inflammatory Bowel Disease Patients: A Narrative Review. J Clin Med 2021; 10:jcm10051040. [PMID: 33802483 PMCID: PMC7959457 DOI: 10.3390/jcm10051040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/12/2021] [Accepted: 02/24/2021] [Indexed: 12/13/2022] Open
Abstract
The biologic era has greatly improved the treatment of Crohn’s disease and ulcerative colitis. Biologics can however induce a wide variety of skin eruptions, especially those targeting the TNF-α and Th17 pathway. These include infusion reactions, eczema, psoriasis, lupus, alopecia areata, vitiligo, lichenoid reactions, granulomatous disorders, vasculitis, skin cancer, and cutaneous infections. It is important to recognize these conditions as treatment-induced adverse reactions and adapt the treatment strategy accordingly. Some conditions can be treated topically while others require cessation or switch of the biological therapy. TNF-α antagonists have the highest rate adverse skin eruptions followed by ustekinumab and anti-integrin receptor blockers. In this review, we provide an overview of the most common skin eruptions which can be encountered in clinical practice when treating IBD (Inflammatory bowel disease) patients and propose a therapeutic approach for each condition.
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44
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Liu T, Li S, Ying S, Tang S, Ding Y, Li Y, Qiao J, Fang H. The IL-23/IL-17 Pathway in Inflammatory Skin Diseases: From Bench to Bedside. Front Immunol 2020; 11:594735. [PMID: 33281823 PMCID: PMC7705238 DOI: 10.3389/fimmu.2020.594735] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Abstract
Interleukin-17 (IL-17) is an essential proinflammatory cytokine, which is mainly secreted by the CD4+ helper T cells (Th17 cells) and subsets of innate lymphoid cells. IL-17A is associated with the pathogenesis of inflammatory diseases, including psoriasis, atopic dermatitis, hidradenitis suppurativa, alopecia areata, pityriasis rubra pilaris, pemphigus, and systemic sclerosis. Interleukin-23 (IL-23) plays a pivotal role in stimulating the production of IL-17 by activating the Th17 cells. The IL-23/IL-17 axis is an important pathway for targeted therapy for inflammatory diseases. Emerging evidence from clinical trials has shown that monoclonal antibodies against IL-23, IL-17, and tumor necrosis factor are effective in the treatment of patients with psoriasis, atopic dermatitis, hidradenitis suppurativa, pityriasis rubra pilaris, pemphigus, and systemic sclerosis. Here, we summarize the latest knowledge about the biology, signaling, and pathophysiological functions of the IL-23/IL-17 axis in inflammatory skin diseases. The currently available biologics targeting the axis is also discussed.
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Affiliation(s)
- Taoming Liu
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sheng Li
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuni Ying
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shunli Tang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuwei Ding
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yali Li
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianjun Qiao
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Fang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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45
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Chicharro P, Rodríguez-Jiménez P, De la Fuente H, Fraga-Fernández J, Cibrian D, Sánchez-Madrid F, Daudén E. Mixed profile of cytokines in paradoxical eczematous eruptions associated with anti-IL-17 therapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3619-3621.e1. [PMID: 32693213 DOI: 10.1016/j.jaip.2020.06.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Pablo Chicharro
- Department of Dermatology, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain.
| | - Pedro Rodríguez-Jiménez
- Department of Dermatology, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Hortensia De la Fuente
- Department of Immunology, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain; CIBER Cardiovascular (Center for Biomedical Research, Cardiovascular Diseases), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Danay Cibrian
- Department of Immunology, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain; CIBER Cardiovascular (Center for Biomedical Research, Cardiovascular Diseases), Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Sánchez-Madrid
- Department of Immunology, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain; CIBER Cardiovascular (Center for Biomedical Research, Cardiovascular Diseases), Instituto de Salud Carlos III, Madrid, Spain
| | - Esteban Daudén
- Department of Dermatology, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
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