Paradoxical psoriasiform skin eruption in paediatric patients with inflammatory bowel disease treated with tumour necrosis factor-α inhibitors.

IF 3.7 4区 医学 Q1 DERMATOLOGY
Daniel Hilewitz, Sharon Yacobovitz, Shiran Reiss-Huss, Manar Matar, Yael Weintraub, Dror S Shouval, Lev Pavlovsky, Rivka Friedland
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引用次数: 0

Abstract

Background: Tumour necrosis factor α (TNF-α) inhibitor (TNFi)-induced psoriasiform eruptions are a well-known phenomenon among adults. However, data are limited regarding this reaction in children.

Objectives: To describe in paediatric patients with inflammatory bowel disease (IBD) the clinical characteristics of TNFi-induced psoriasiform eruptions and the outcomes of various therapeutic options.

Methods: We reviewed the medical charts of paediatric patients (aged < 18 years) with IBD who developed TNFi-induced psoriasiform eruptions during 2006-2022.

Results: Among 454 patients with IBD treated with TNFis, 58 (12.8%) were diagnosed with TNFi-induced psoriasiform eruptions, of whom 51 were included in the study. The female to male ratio was 1 : 1.3. The median age at skin eruption was 14.11 [interquartile range (IQR) 12.11-16.05] years. The median elapsed time to eruption appearance was 15.00 months (IQR 7.00-24.00) after initiation of the treatment. All 51 patients were treated with topical steroids and 17 (33%) needed systemic treatment (phototherapy, methotrexate or acitretin). Sixteen of 51 patients (31%) needed to stop TNFi treatment because of an intractable eruption. Female patients, patients with inflammatory alopecia and patients who were treated with methotrexate or phototherapy were more prone to stop TNFis.

Conclusions: TNFi-induced psoriasiform eruptions are common in paediatric patients with IBD. The eruption may appear months or even years after treatment initiation. Almost one-third of the described patients had to replace their treatment because of a recalcitrant cutaneous eruption. This indicates that a multidisciplinary approach is required.

接受 TNFα 抑制剂治疗的炎症性肠病小儿患者中出现的矛盾性牛皮癣样皮肤破溃。
背景:肿瘤坏死因子α抑制剂(TNFαI)诱发的银屑病疹在成人中是一种众所周知的现象。然而,有关儿童这种反应的数据却很有限:目的:描述炎症性肠病(IBD)儿科患者中 TNFαI 诱导的银屑病样溃疡的临床特征以及各种治疗方案的效果:方法:我们查阅了儿童患者(岁)的病历:在454例接受TNFαI治疗的IBD患者中,有58例(12.8%)被诊断为TNFαI诱发的银屑病样疹子,其中51例被纳入研究。男女比例为1:1.3。发病年龄的中位数为14.1岁[四分位距为12.11-16.05岁]。开始治疗后,出现糜烂的中位时间为 15 个月[四分位数间距为 7-24 个月]。所有患者都接受了局部类固醇治疗,17 名患者(33%)需要接受全身治疗(光疗、甲氨蝶呤或阿昔替林)。16名患者(31%)因溃疡难治而需要停止TNFαI治疗。女性患者、炎症性脱发患者以及接受过甲氨蝶呤或光疗的患者更容易停止TNFαI治疗:结论:TNFαI诱发的银屑病样皮疹在儿童IBD患者中很常见。牛皮癣可能在开始治疗数月甚至数年后才出现。在描述的患者中,近三分之一的患者因皮肤糜烂顽固而不得不更换治疗方案。这表明,需要采用多学科方法进行有效治疗。
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来源期刊
CiteScore
3.20
自引率
2.40%
发文量
389
审稿时长
3-8 weeks
期刊介绍: Clinical and Experimental Dermatology (CED) is a unique provider of relevant and educational material for practising clinicians and dermatological researchers. We support continuing professional development (CPD) of dermatology specialists to advance the understanding, management and treatment of skin disease in order to improve patient outcomes.
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