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Wang Y, Yang F, Wang R, Luo S. Paradoxical psoriasis induced by IL-17 antagonists. Indian J Dermatol Venereol Leprol 2024; 0:1-9. [PMID: 38594973 DOI: 10.25259/ijdvl_719_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/20/2023] [Indexed: 04/11/2024]
Abstract
Background The paradoxical occurrence of psoriasis triggered by Interleukin-17 (IL-17) inhibitors is notable due to its prominent symptoms and the therapeutic dilemma it presents for follow-up care. Objective To describe cases in our clinic, perform an in-depth literature review, and suggest the most probable mechanisms of action. Method We conducted a literature review on published cases of IL-17 inhibitor-induced psoriasis. Results We found 22 articles reporting 30 cases of IL-17 inhibitor-induced paradoxical psoriasis, primarily observed in patients with a previous psoriasis history. Almost 60% of cases showed a change in lesion morphology, with the plaque or pustular type being prevalent. About 73.3% of patients had to discontinue the implicated drug, leading to partial or complete symptom resolution. The mechanism behind this response seemed to involve IL-17 inhibitors downregulating Tumour Necrosis Factor alpha (TNF-α), subsequently upregulating plasmacytoid dendritic cells and triggering unopposed IFN-alpha (IFN-α) production. Limitation Data are confined to case reports and case series. Conclusion More assertive measures are recommended for treating paradoxical psoriasis induced by IL-17 inhibitors than those caused by TNF-α inhibitors. Reintroducing an IL-17 inhibitor is not advised, as patients did not show improvement.
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Affiliation(s)
- Yachen Wang
- Department of Dermatology, Tianjin Medical University General Hospital, Anshan Dao, Tianjin, China
| | - Fengling Yang
- Department of Dermatology, Tianjin Medical University General Hospital, Anshan Dao, Tianjin, China
| | - Ruizhe Wang
- Department of Dermatology, Tianjin Medical University General Hospital, Anshan Dao, Tianjin, China
| | - Suju Luo
- Department of Dermatology, Tianjin Medical University General Hospital, Anshan Dao, Tianjin, China
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Klimko A, Olteanu AO, Tieranu I, Orzan OA, Toma CV, Ionescu EM, Preda CM, Tieranu CG. Paradoxical Psoriasis Induced by Ustekinumab: A Comprehensive Review and Case Report. Medicina (Kaunas) 2024; 60:106. [PMID: 38256367 PMCID: PMC10818897 DOI: 10.3390/medicina60010106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/25/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Ustekinumab (UST), a biologic agent targeting interleukin-12 and interleukin-23, is widely used in the management of psoriasis and Crohn's disease. Despite its efficacy, there have been instances of paradoxical psoriasis induction or exacerbation in some patients during UST therapy. This paper offers a comprehensive review of reported cases of UST-induced paradoxical psoriasis, including a case from our clinic. We focus on a 39-year-old female patient with a history of long-standing Crohn's disease who developed a psoriasiform rash, as confirmed by biopsy, while undergoing UST treatment. The patient's clinical journey, from initial diagnosis through the complexities of treatment adjustments due to various complications including drug-induced lupus and the subsequent onset of psoriatic manifestations, provides insight into the challenges encountered in the clinical management of such cases. This review emphasizes the necessity for clinicians to recognize the possibility of paradoxical psoriasis in patients receiving UST treatment and calls for further research to better understand this phenomenon and devise effective management strategies.
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Affiliation(s)
- Artsiom Klimko
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, University Hospital Zurich, 8091 Zürich, Switzerland;
| | - Andrei Ovidiu Olteanu
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.O.O.); (E.M.I.); (C.M.P.); (C.G.T.)
- Department of Gastroenterology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Ioana Tieranu
- Department of Pediatrics, “Maria Sklodowska Curie” Clinical Emergency Hospital for Children, 077120 Bucharest, Romania;
| | - Olguta Anca Orzan
- Department of Dermatology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Dermatology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Cristian Valentin Toma
- Department of Inovation and e-Health, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Elena Mirela Ionescu
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.O.O.); (E.M.I.); (C.M.P.); (C.G.T.)
- Department of Gastroenterology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Carmen Monica Preda
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.O.O.); (E.M.I.); (C.M.P.); (C.G.T.)
- Department of Gastroenterology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Cristian George Tieranu
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.O.O.); (E.M.I.); (C.M.P.); (C.G.T.)
- Department of Gastroenterology, Elias Emergency University Hospital, 011461 Bucharest, Romania
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3
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Revankar R, Patel H, Rojas M, Walsh S, McGee JS. Systematic review of TNFα-induced paradoxical psoriasis: Treatment outcomes of switching to alternative biologic therapies in inflammatory bowel disease patients. J DERMATOL TREAT 2023; 34:2133533. [PMID: 36205507 DOI: 10.1080/09546634.2022.2133533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The objective of this systematic review was to evaluate the efficacies of different biologic therapies in treating tumor necrosis factor-alpha (TNFα)-induced paradoxical psoriasis (PXP) and controlling inflammatory bowel disease (IBD) symptoms. METHODS We conducted a literature search of the Ovid EMBASE, Ovid Medline, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials databases from their inception to October 3, 2021. We considered all peer-reviewed, randomized controlled trials, chart reviews, and observational studies that discussed the TNFα-induced PXP treatment outcomes in IBD patients of switching to different biologic therapies. RESULTS Switching to ustekinumab (UST) resulted in complete or partial resolution of TNFα-induced PXP in 83.1% of patients (74 out of 89 patients), while switching to either vedolizumab (VDZ) or secukinumab led to complete resolution in 100% of patients (eight out of eight patients). Approximately 75.4% of patients who were switched to UST remained in IBD remission, 4.6% in partial remission, and 20.0% in the flare of IBD. CONCLUSIONS UST has sufficient data to demonstrate the efficacy in treating TNFα-induced PXP and controlling IBD symptoms concurrently. More data is needed to validate the efficacies of VDZ and SEC in treating TNFα-induced PXP in IBD patients.
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Affiliation(s)
- Rishab Revankar
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Heli Patel
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Mary Rojas
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samantha Walsh
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jean S McGee
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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4
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Alnaqbi KA, Al Zeyoudi J, Fazal F, Alhaj OM, Jassim I, Albreiki FA. Paradoxical Psoriasis and Worsening Spondylitis Due to Secukinumab in a Patient With Ankylosing Spondylitis: A Case Report and Literature Review. Cureus 2023; 15:e50726. [PMID: 38111814 PMCID: PMC10726796 DOI: 10.7759/cureus.50726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 12/20/2023] Open
Abstract
Axial spondyloarthritis (axSpA) is an autoimmune disease primarily affecting the axial skeleton, with associated extra-musculoskeletal manifestations. Treatment strategies targeting cytokines tumor necrosis factor-alpha (TNF-α) and interleukin 17 (IL-17) have proven effective. However, paradoxical reactions, including paradoxical psoriasis and arthritis, have been reported in axSpA patients receiving TNF-α inhibitors. IL-17 inhibitors have been used as an alternative treatment option, but paradoxical reactions have also been rarely observed. This case report presents a 45-year-old man with axSpA who responded to infliximab for six years before discontinuing it due to secondary failure. After the washout period of infliximab, he was started on secukinumab but developed paradoxical psoriasis and worsening of inflammatory back pain after receiving the second loading dose which necessitated replacing it with upadacitinib. Complete resolution of paradoxical psoriasis and significant improvement in his back pain after three months ensued. This case contributes to understanding the complex dynamics in treating axSpA and managing paradoxical reactions.
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Affiliation(s)
- Khalid A Alnaqbi
- Internal Medicine, Tawam Hospital and College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, ARE
- Internal Medicine/Rheumatology, Tawam Hospital, Al Ain, ARE
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6
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Muacevic A, Adler JR. Atypical Dermatitis Herpetiform and Scalp Psoriasis in Ulcerative Colitis Patient Treated With Adalimumab. Cureus 2023; 15:e35317. [PMID: 36846641 PMCID: PMC9947429 DOI: 10.7759/cureus.35317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 02/24/2023] Open
Abstract
Adalimumab is a blocker of tumor necrosis factor (TNF)-alpha with established efficacy in the treatment of ulcerative colitis. However, literature indicated that adalimumab can, occasionally, induce paradoxical psoriasis reactions and, very rarely, dermatitis herpetiformis. We present a unique case of a 26-year-old female patient who developed a combination of dermatitis herpetiformis and scalp psoriasis paradoxically as a result of adalimumab treatment for ulcerative colitis. To the best of our knowledge, this is the first case of such a combination within the context of adalimumab therapy. The etiopathological underpinning of such a reaction remains elusive but is speculated to be complex and involves the interaction of several immunological and dermatological mechanisms. Adalimumab therapy is associated with a genuine risk for the development of paradoxical psoriasis and dermatitis herpetiformis. We, through this case report, added to the evidence confirming such an association. Clinicians should follow these potential adverse effects and make every effort to warn patients of their likelihood.
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7
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Croitoru DO, Brooks SG, Nathanielsz N, Silverberg O, Nicolau I, Drucker AM, Silverberg M, Yeung J, Limacher JJ, Piguet V. Predictors of severity in paradoxical psoriasis from biologic therapies: A systematic review. J Am Acad Dermatol 2023; 88:471-473. [PMID: 35718193 DOI: 10.1016/j.jaad.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 01/17/2023]
Affiliation(s)
- David O Croitoru
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Steph G Brooks
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nikki Nathanielsz
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Orli Silverberg
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ioana Nicolau
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Aaron M Drucker
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, Toronto, Ontario, Canada; Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
| | - Mark Silverberg
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Gastroenterology, Department of Medicine, Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - Jensen Yeung
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, Toronto, Ontario, Canada; Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada; Division of Dermatology, Sunnybrook Hospital, Toronto, Ontario, Canada
| | - James J Limacher
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, Toronto, Ontario, Canada; Division of Pathology, Women's College Hospital, Toronto, Ontario, Canada
| | - Vincent Piguet
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada; Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada.
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8
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Burzi L, Repetto F, Ribero S, Mastorino L, Quaglino P, Dapavo P. Paradoxical psoriasiform reactions during treatment with adalimumab for hidradenitis suppurativa: Real-life experience and therapeutic response to other biological drugs. Dermatol Ther 2022; 35:e15866. [PMID: 36175129 PMCID: PMC10078212 DOI: 10.1111/dth.15866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/15/2022] [Accepted: 09/25/2022] [Indexed: 11/27/2022]
Abstract
Adalimumab is the only biological drug approved to date for the treatment of moderate and/or severe hidradenitis suppurativa. Adverse events reported during therapy include paradoxical psoriasiform reactions. No guidelines are currently available for the management of this clinical condition. The aim of this paper is to describe the incidence and clinical features of paradoxical psoriasiform eruptions occurring during treatment with adalimumab in patients with hidradenitis suppurativa and to report real-life experience in management and the possible role of other biologic agents for the treatment of both conditions.
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Affiliation(s)
- Lorenza Burzi
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Federica Repetto
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Simone Ribero
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luca Mastorino
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Dapavo
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
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9
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Neema S, Vendhan S, Vasudevan B, A W K, Thombre R. Rituximab induced new onset palmo-plantar pustulosis in patient with pemphigus foliaceus- A rare adverse effect. Dermatol Ther 2022; 35:e15714. [PMID: 35821203 DOI: 10.1111/dth.15714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/21/2022] [Accepted: 07/09/2022] [Indexed: 11/28/2022]
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10
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Townsend CM, Lovegrove F, Khanna R, Wilson AS. Review article: paradoxical psoriasis as a consequence of tumour necrosis factor antagonists in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2022; 55:1379-1388. [PMID: 35312094 DOI: 10.1111/apt.16883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/12/2022] [Accepted: 02/28/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Tumour necrosis factor (TNF) antagonists are an efficacious therapy used in the management of several immune-mediated inflammatory diseases, including inflammatory bowel disease (IBD) and psoriasis. However, since being prescribed more widely, reports of new-onset psoriatic lesions have began to emerge in the literature and are known as paradoxical psoriasis. AIM To review the evidence available in both the dermatology and gastroenterology literature pertaining to the entity known as paradoxical psoriasis as it relates to IBD and to create a comprehensive guide to assist clinicians who treat this challenging patient population. METHODS A literature search was conducted in PubMed to identify manuscripts that presented, discussed or summarised data pertaining to paradoxical psoriasis presenting in individuals with IBD. RESULTS Paradoxical psoriasis is now thought to be a contradictory effect of TNF antagonist therapy leading to psoriatic lesions often within the first year of treatment. The underlying pathogenesis, although not completely understood, is likely related to an imbalance of inflammatory cytokines. The histological appearance, while similar to classical psoriasis, does have unique features. The clinical presentation can vary among patients but often presents during maintenance therapy for inflammatory bowel disease. Treatment options should be determined based upon the severity of the skin lesion, activity of the underlying inflammatory bowel disease and the patient's unique clinical history. CONCLUSIONS The approach to paradoxical psoriasis in IBD should be discussed with a multidisciplinary team to optimise and preserve intestinal disease remission and to ensure the resolution of debilitating skin lesions.
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Affiliation(s)
- Cassandra Marie Townsend
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Fiona Lovegrove
- Department of Medicine, Schulich School of Medicine, Western University, London, Ontario, Canada.,Lovegrove Dermatology, London, Ontario, Canada
| | - Reena Khanna
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
| | - Aze Suzanne Wilson
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada.,Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada.,Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
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11
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Murphy MJ, Cohen JM, Vesely MD, Damsky W. Paradoxical eruptions to targeted therapies in dermatology: A systematic review and analysis. J Am Acad Dermatol 2020; 86:1080-1091. [PMID: 33307146 DOI: 10.1016/j.jaad.2020.12.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Antibody-based therapies that inhibit proinflammatory cytokine signaling are commonly used in dermatology. Paradoxically, these medications may induce or exacerbate inflammatory disorders. OBJECTIVE To summarize the spectrum of manifestations, incidence, timing, potential mechanisms of, and general management approaches to paradoxical cutaneous reactions induced by cytokine-targeted antibodies in dermatology. METHODS We performed a systematic review and analysis of published cases of cutaneous paradoxical reactions (PRs) reported in association with tumor necrosis factor α, interleukin (IL) 12/23 (p40), IL-17A/17R, IL-23 (p19), and IL-4Rα inhibitors. RESULTS We identified 313 articles reporting 2049 cases of PRs. Tumor necrosis factor α inhibitors resulted in 91.2% (1869/2049) of all cases, followed by IL-17/17R (3.5%), IL-4Rα (2.7%), IL-12/23 (2.4%), and IL-23 (0.01%) inhibitors. Psoriasiform and eczematous eruptions were the most commonly reported, but a wide spectrum of patterns were described. Phenotypically overlapping reaction patterns were common. Time to onset typically ranged from weeks to months but could occur more than a year later. Improvement or resolution upon discontinuation of the inciting drug was common. LIMITATIONS This was a retrospective analysis. CONCLUSIONS Familiarity with the clinical features of PRs from cytokine-blocking antibodies may facilitate efficient recognition and management.
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Affiliation(s)
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven
| | | | - William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven.
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12
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Bucalo A, Rega F, Zangrilli A, Silvestri V, Valentini V, Scafetta G, Marraffa F, Grassi S, Rogante E, Piccolo A, Cucchiara S, Viola F, Bianchi L, Ottini L, Richetta A. Paradoxical Psoriasis Induced by Anti-TNFα Treatment: Evaluation of Disease-Specific Clinical and Genetic Markers. Int J Mol Sci 2020; 21:E7873. [PMID: 33114187 DOI: 10.3390/ijms21217873] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 02/08/2023] Open
Abstract
Paradoxical psoriasis (PP) may occur during treatment with anti-tumor necrosis factor-alpha (TNF-α) drugs in various chronic immune-mediated diseases, mainly inflammatory bowel diseases (IBD) and psoriasis. In this study, clinical and genetic characteristics of PP arising in IBD and psoriatic patients were investigated to identify disease-specific markers of the paradoxical effect. A total of 161 IBD and psoriatic patients treated with anti-TNF-α drugs were included in the study. Of these patients, 39 developed PP. All patients were characterized for the main clinical–pathologic characteristics and genotyped for six candidate single nucleotide polymorphisms (SNPs) selected for their possible role in PP susceptibility. In IBD patients, the onset of PP was associated with female sex, presence of comorbidities, and use of adalimumab. IBD patients with PP had a higher frequency of the TNF-α rs1799964 rare allele (p = 0.006) compared with cases without the paradoxical effect, and a lower frequency of the human leucocyte antigen (HLA)-Cw06 rs10484554 rare allele (p = 0.03) compared with psoriatic patients with PP. Overall, these findings point to specific clinical and genetic characteristics of IBD patients with PP and provide data showing that genetic variability may be related to the paradoxical effect of anti-TNF-α drugs with possible implications into clinical practice.
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13
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Ya J, Hu JZ, Nowacki AS, Khanna U, Mazloom S, Kabbur G, Husni ME, Fernandez AP. Family history of psoriasis, psychological stressors, and tobacco use are associated with the development of tumor necrosis factor-α inhibitor-induced psoriasis: A case-control study. J Am Acad Dermatol 2020; 83:1599-1605. [PMID: 32592879 DOI: 10.1016/j.jaad.2020.06.081] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 06/13/2020] [Accepted: 06/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Tumor necrosis factor-α inhibitor-induced psoriasis (TNFI psoriasis) is a paradoxical reaction characterized by development of a psoriasiform rash that mimics psoriasis vulgaris. Temporal onset variability and low incidence rates suggest that underlying risk factors or outside triggers have a role in TNFI psoriasis initiation. OBJECTIVES We aimed to identify underlying risk factors and outside triggers associated with TNFI psoriasis onset. METHODS This case-control study included 97 patients at a tertiary care center between 2003 and 2013 who developed TNFI psoriasis. Ninety-seven control patients were matched to age, sex, disease, TNF-α inhibitor, and length of time on treatment before TNFI psoriasis onset. Patient medical records were reviewed ≥6 months immediately preceding TNFI psoriasis onset (similar equivalent time point for matched controls) for information about potential risk factors and outside factors categorized as: (1) serologic abnormalities, (2) acute events, and (3) social factors. RESULTS Compared with those of matched controls, odds ratios (ORs) were significantly higher in the TNFI psoriasis group for psoriasis family history (OR, 16.0) and acute psychological stressors (OR, 3.14) and marginally associated with tobacco use (OR, 1.76). CONCLUSIONS Our results suggest that psoriasis family history, psychological stressors, and tobacco use might be risk factors for developing TNFI psoriasis. Performing detailed patient histories when considering TNFI therapy may be useful in identifying patients at risk for TNFI-psoriasis.
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Affiliation(s)
- Jason Ya
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Jeffery Z Hu
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Amy S Nowacki
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Urmi Khanna
- Department of Dermatology and Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | - Gowri Kabbur
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - M Elaine Husni
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
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14
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Abstract
This case report describes a patient with plaque psoriasis and psoriatic arthritis who experienced IL-17A blocking antibody secukinumab treatment-interruption followed by re-treatment. The patient showed heterogeneous responses; significant improvement at initial introduction of secukinumab with rapid deterioration after discontinuation, followed by worsening symptoms and pustular eruption with reintroduction, and skin clearance after dose escalation.
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Affiliation(s)
- Mohamed El-Komy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa Amer
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Alshimaa Mostafa
- Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Dermatology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Mona ElKalioby
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
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15
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Fania L, Morelli M, Scarponi C, Mercurio L, Scopelliti F, Cattani C, Scaglione GL, Tonanzi T, Pilla MA, Pagnanelli G, Mazzanti C, Girolomoni G, Cavani A, Madonna S, Albanesi C. Paradoxical psoriasis induced by TNF-α blockade shows immunological features typical of the early phase of psoriasis development. J Pathol Clin Res 2019; 6:55-68. [PMID: 31577850 PMCID: PMC6966707 DOI: 10.1002/cjp2.147] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022]
Abstract
Immunomodulation with anti‐TNF‐α is highly effective in the treatment of various immune‐mediated inflammatory diseases, including hidradenitis suppurativa (HS). However, this may be responsible for unexpected paradoxical psoriasiform reactions. The pathogenic mechanisms underlying the induction of these events are not clear, even though the involvement of innate immune responses driven by plasmacytoid dendritic cells (pDC) has been described. In addition, the genetic predisposition to psoriasis of patients could be determinant. In this study, we investigated the immunological and genetic profiles of three HS patients without psoriasis who developed paradoxical psoriasiform reactions following anti‐TNF‐α therapy with adalimumab. We found that paradoxical psoriasiform skin reactions show immunological features common to the early phases of psoriasis development, characterized by cellular players of innate immunity, such as pDC, neutrophils, mast cells, macrophages, and monocytes. In addition, IFN‐β and IFN‐α2a, two type I IFNs typical of early psoriasis, were highly expressed in paradoxical skin reactions. Concomitantly, other innate immunity molecules, such as the catheledicin LL37 and lymphotoxin (LT)‐α and LT‐β were overproduced. Interestingly, these innate immunity molecules were abundantly expressed by keratinocytes, in addition to the inflammatory infiltrate. In contrast to classical psoriasis, psoriasiform lesions of HS patients showed a reduced number of IFN‐γ and TNF‐α‐releasing T lymphocytes. On the contrary, IL‐22 immunoreactivity was significantly augmented together with the IL‐36γ staining in leukocytes infiltrating the dermis. Finally, we found that all HS patients with paradoxical reactions carried allelic variants in genes predisposing to psoriasis. Among them, SNPs in ERAP1, NFKBIZ, and TNFAIP genes and in the HLA‐C genomic region were found.
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Affiliation(s)
- Luca Fania
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy
| | - Martina Morelli
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy.,Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - Claudia Scarponi
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy
| | - Laura Mercurio
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy
| | - Fernanda Scopelliti
- Istituto Nazionale per la promozione della salute delle popolazioni Migranti ed il contrasto delle malattie della Povertà, INMP, Rome, Italy
| | - Caterina Cattani
- Istituto Nazionale per la promozione della salute delle popolazioni Migranti ed il contrasto delle malattie della Povertà, INMP, Rome, Italy
| | - Giovanni Luca Scaglione
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy.,Laboratory of Molecular Oncology, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Campobasso, Italy
| | - Tiziano Tonanzi
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy
| | - Maria Antonietta Pilla
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy
| | - Gianluca Pagnanelli
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy
| | - Cinzia Mazzanti
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy
| | - Giampiero Girolomoni
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Cavani
- Istituto Nazionale per la promozione della salute delle popolazioni Migranti ed il contrasto delle malattie della Povertà, INMP, Rome, Italy
| | - Stefania Madonna
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy
| | - Cristina Albanesi
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy
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16
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Abstract
Chronic plaque psoriasis is a common debilitating skin disease. The identification of the pathogenic role of the TNF/IL-23/TH17 pathway has enabled the development of targeted therapies used in the clinic today. Particularly, TNF inhibitors have become a benchmark for the treatment of numerous chronic inflammatory diseases such as psoriasis. Although being highly effective in psoriasis treatment, anti-TNFs can themselves induce psoriasis-like skin lesions, a side effect called paradoxical psoriasis. In this review, we provide a comprehensive look at the different cellular and molecular players involved in classical plaque psoriasis and contrast its pathogenesis to paradoxical psoriasis, which is clinically similar but immunologically distinct. Classical psoriasis is a T-cell mediated autoimmune disease driven by TNF, characterised by T-cells memory, and a relapsing disease course. In contrast, paradoxical psoriasis is caused by the absence of TNF and represents an ongoing type-I interferon-driven innate inflammation that fails to elicit T-cell autoimmunity and lacks memory T cell-mediated relapses.
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Affiliation(s)
- Alessio Mylonas
- Department of Dermatology, University Hospital CHUV, Lausanne, Switzerland
| | - Curdin Conrad
- Department of Dermatology, University Hospital CHUV, Lausanne, Switzerland
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17
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Abstract
Anti-TNFα drugs have been shown to be effective for maintaining stable remission in patients with Crohn's disease. However, some problems have been identified during clinical use of this class of drugs, such as secondary treatment failure, in which the drugs become progressively less effective with time, and the development of paradoxical reactions such as psoriatic skin symptoms. Thus, while anti-TNFα drugs are used to treat psoriasis, they can sometimes also cause paradoxical psoriasis, characterized by the appearance of psoriasis-like eruptions, which has recently begun to attract attention. Furthermore, inflammatory bowel disease is not only associated with intestinal lesions, but also with a variety of extraintestinal manifestations, of which arthritis is relatively common. We encountered a case of Crohn's disease with arthritis, as an extraintestinal manifestation, and paradoxical psoriasis caused by infliximab treatment, in which ustekinumab proved extremely effective, not only for alleviating the arthritis, but also against the skin manifestations. To the best of our knowledge, this is the first reported case of the efficacy of ustekinumab against paradoxical psoriasis and arthritis in a patient with Crohn's disease.
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Affiliation(s)
- Satohiro Matsumoto
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
| | - Hirosato Mashima
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
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18
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Ishii-Osai Y, Yoneta A, Mizugaki N, Takahashi H, Yamashita T. Infliximab treatment-induced paradoxical psoriasiform reaction in patient with psoriasis vulgaris showing positive lymphocyte transportation test reaction. JAAD Case Rep 2015; 1:230-3. [PMID: 27051738 PMCID: PMC4808732 DOI: 10.1016/j.jdcr.2015.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yasue Ishii-Osai
- Correspondence to: Yasue Ishii-Osai, MD, Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, 060-8543, Japan.
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