Eczematous Eruption on Hands and Feet After Treatment With Biological Agents for Psoriasis

IF 3.4 4区医学 Q1 DERMATOLOGY

Dermatologic Therapy Pub Date : 2025-10-13 DOI:10.1155/dth/1668153

Fen Peng, Hio Fong Leong, Zhi-Lin Sun, Wen-Hui Wang

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引用次数: 0

Abstract

Objective

To summarize and analyze the clinical diagnosis and patient management of immune drift in psoriasis.

Methods

Review the cases of psoriasis patients in the Peking University Third Hospital dermatology inpatient room from 2022 to 2023 and analyze three patients who developed eczema on hands and feet after treatment with biological agents. Review databases such as PubMed, Medline, and Embase databases to summarize the cases of immune drift induced by biological therapy for psoriasis reported in the literature.

Results

A total of 57 patients were included in the literature search combined with the 3 patients reported in this article for discussion. In previous studies, the biologics involved include the following: adalimumab (22 cases), infliximab (5 cases), etanercept (6 cases), ixekizumab (7 cases), secukinumab (10 cases), ustekinumab (15 cases), and guselkumab (3 cases). Among them, 8 patients experienced immune drift reactions to more than one biological agent. Among these patients, the proportion of male patients is 54%, and the proportion of female patients is 46%, with the age being (42.5 ± 24.5) years. The time from the initiation of biologic therapies to the onset of eczematous rash varies from 4 days to 22 months. The main manifestation included erythema, papules with exudation or scales, and the affected areas include the scalp, face, neck, trunk, and limbs. In previous studies, 47 patients reported laboratory indicators, of which 23 (48.9%) had elevated eosinophils and 9 (19.1%) had elevated IgE levels. A total of 10 patients reported biopsy results, all of which were consistent with eczema. Previous studies have reported 34 cases of treatment outcomes. Among them, 23 cases stopped using their original biologics and were changed to other types of biologics or small-molecule drugs, or treated with systemic glucocorticoids, cyclosporine, and methotrexate. In addition, 11 cases continued to use their previous biologics, of which 8 patients improved after topical glucocorticoids treatment and 3 cases did not receive any treatment and improved. Among the 3 patients reported in this article, 2 had elevated serum total IgE and 1 had elevated eosinophils. The three patients all stopped using previous biologics and improved after treatment with other types of biologics or systemic glucocorticoids and immunosuppressants.

Conclusions

Biologic therapy plays an important role in the treatment of psoriasis, but their paradoxical reactions, especially immune drift, are also worth our attention. In clinical decision-making for psoriasis, we should consider in advance whether the patient has atopic histories and can also use genetic tests to choose more suitable biologics for treatment.

Abstract Image

查看原文本刊更多论文

生物制剂治疗银屑病后手和脚的湿疹爆发

目的总结分析银屑病患者免疫漂移的临床诊断及处理方法。方法回顾性分析北京大学第三医院皮肤科2022 - 2023年收治的银屑病患者，分析3例经生物制剂治疗后出现手足湿疹的患者。回顾PubMed、Medline和Embase等数据库，总结文献中报道的银屑病生物治疗诱导免疫漂移的病例。结果文献检索共纳入57例患者，结合本文报道的3例患者进行讨论。在以往的研究中，涉及的生物制剂包括：阿达木单抗（22例）、英夫利昔单抗（5例）、依那西普（6例）、伊克珠单抗（7例）、secukinumab（10例）、ustekinumab（15例）、guselkumab（3例）。其中8例患者出现对一种以上生物制剂的免疫漂变反应。其中男性占54%，女性占46%，年龄为（42.5±24.5）岁。从开始生物治疗到湿疹皮疹发作的时间从4天到22个月不等。主要表现为红斑、丘疹伴渗出或鳞屑，累及部位包括头皮、面部、颈部、躯干和四肢。在以往的研究中，47例患者报告了实验室指标，其中23例（48.9%）有嗜酸性粒细胞升高，9例（19.1%）有IgE升高。共有10例患者报告了活检结果，所有结果都与湿疹一致。先前的研究报告了34例治疗结果。其中23例患者停用原生物制剂，改用其他生物制剂或小分子药物，或全身性应用糖皮质激素、环孢素、甲氨蝶呤等治疗。此外，11例患者继续使用原生物制剂，其中8例患者经局部糖皮质激素治疗后病情好转，3例患者未接受任何治疗而病情好转。在本文报道的3例患者中，2例血清总IgE升高，1例嗜酸性粒细胞升高。3例患者均停止使用既往生物制剂，经其他类型生物制剂或全身性糖皮质激素和免疫抑制剂治疗后病情好转。结论生物疗法在银屑病的治疗中发挥着重要作用，但其矛盾反应，特别是免疫漂移，也值得我们重视。在银屑病的临床决策中，我们应该提前考虑患者是否有特应性病史，也可以通过基因检测来选择更合适的生物制剂进行治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Dermatologic Therapy 医学-皮肤病学

CiteScore

7.00

自引率

8.30%

发文量

711

审稿时长

3 months

期刊介绍： Dermatologic Therapy has been created to fill an important void in the dermatologic literature: the lack of a readily available source of up-to-date information on the treatment of specific cutaneous diseases and the practical application of specific treatment modalities. Each issue of the journal consists of a series of scholarly review articles written by leaders in dermatology in which they describe, in very specific terms, how they treat particular cutaneous diseases and how they use specific therapeutic agents. The information contained in each issue is so practical and detailed that the reader should be able to directly apply various treatment approaches to daily clinical situations. Because of the specific and practical nature of this publication, Dermatologic Therapy not only serves as a readily available resource for the day-to-day treatment of patients, but also as an evolving therapeutic textbook for the treatment of dermatologic diseases.