A case of dupilumab‐induced reverse psoriasis in a patient with atopic dermatitis

Fan, Jiaming; Zhang, Liwen; Lu, Yiming; Zhou, Peimei

doi:10.1111/dth.15345

Cited by 8 publications

(5 citation statements)

References 8 publications

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“…Although it has not been indicated for the treatment of psoriasis, this monoclonal antibody may be associated with psoriasis or psoriasiform dermatitis in patients with atopic dermatitis. This type of psoriasis appears to be immunologically distinct from classical psoriasis, and some cases were described as ‘‘psoriasiform’’ because they did not necessarily meet the definition of psoriasis [ 66 , 67 , 68 , 69 , 70 ]. Although a switch in the polarization of the predominant immune response from Th 2 to Th 17 was hypothesized, a deeper understanding of the mechanism behind this reaction to dupilumab will lead to the complete comprehension of the immunopathogeneses of psoriasis and atopic dermatitis [ 71 ].…”

Section: Psoriasis Biologics and Skin Patch Testingmentioning

confidence: 99%

Allergic Contact Cell-Mediated Hypersensitivity in Psoriasis: A Narrative Minireview

et al. 2022

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The dysfunctionality of the protective skin barrier in psoriasis allows easier cutaneous penetration of various contact haptens; thus, such patients can develop allergic contact hypersensitivity as a comorbidity. Both skin conditions involve T-cell-mediated mechanisms. Dermatologists and allergists should consider assessing allergic contact cell-mediated hypersensitivity in selected psoriasis patients, especially those with palmoplantar psoriasis and who are refractory to topical treatments, and in patients with psoriasis, with or without arthritis, treated with biologics that present skin lesions clinically suggestive of contact dermatitis.

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Section: Psoriasis Biologics and Skin Patch Testingmentioning

confidence: 99%

Allergic Contact Cell-Mediated Hypersensitivity in Psoriasis: A Narrative Minireview

et al. 2022

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“…For example, AD in Asian populations have both the characteristics of PsO and AD in European and American populations, where Th2, Th17, and Th22 are all activated at the lesions ( 28 ), as shown in Figure 1 . The application of biologics can lead to changes in T cell polarity and induce paradoxical dermatoses, such as the control of Th2 cells may lead to the transformation into Th1 and Th17 cells, thus causing PsO ( 29 ). Inhibiting Th1/Th17 cells may lead to conversion to Th2 cells, causing AD.…”

Section: Paradoxical Dermatosesmentioning

confidence: 99%

Application of JAK inhibitors in paradoxical reaction through immune-related dermatoses

Zhang,

Jiang

2024

Front. Immunol.

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Biologics play a positive and effective role in the treatment of immune-related dermatoses. However, many other immune-related diseases have also manifested along with biologics treatment. Paradoxical reaction through immune-related dermatoses refer to the new onset or exacerbation of other immune-mediated dermatoses (mainly psoriasis and atopic dermatitis) after biologics treatment of inflammatory dermatoses (mainly psoriasis and atopic dermatitis), such as new atopic dermatitis (AD) in psoriasis (PsO) treatment and new PsO in AD treatment. A common genetic background and Inflammatory pathway are possible pathogenesis. Faced with paradoxical reactions, the choice of therapy needs to be directed toward therapies effective for both diseases, such as Janus kinase (JAK) inhibitors. The Janus kinase and signal transducer and activator of transcription (JAK-STAT) pathway plays an important role in the inflammatory pathway, and has been widely used in the treatment of AD and PsO in recent years. This article focuses on JAK inhibitors such as tofacitinib, baricitinib, ruxolitinib, Abrocitinib, upadacitinib, and deucravacitinib, to explore the possible application in treatment of paradoxical reactions. Common side effects, baseline risk factors and safety use of JAK inhibitors were discussed.

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“…However, Jaulent et al [38] reported a high proportion of pustular psoriasis (43%, 3/7) as a specific clinical feature in DAPs/PsM. Some specific variants of psoriasis, such as reverse psoriasis and sebopsoriasis, could also occur in patients with dupilumab therapy [22, 30]. Sebopsoriasis, as a combination of psoriasis and seborrheic dermatitis, was thought to result from the abnormal immune response to Malassezia induced by cytokine imbalances due to dupilumab [22].…”

Section: Clinical Manifestations Of Daps/psmmentioning

confidence: 99%

“…Palmoplantar and nail psoriasis have also been reported, occurring alone or in combination with lesions elsewhere [9, 20, 25, 28]. Recently, Fan et al [30] reported a case of reverse psoriasis occurring in the armpits, indicating that flexural and intertriginous areas could also be affected by DAPs/PsM, especially easy to be confused with preexisting AD. Psoriatic plaques were mostly noticed in areas of skin that had not been affected by AD before, but a few cases revealed that psoriasis appeared on the original lesions, switching from AD to psoriasis directly [14, 32].…”

Section: Clinical Manifestations Of Daps/psmmentioning

confidence: 99%

Dupilumab-Associated Psoriasis and Psoriasiform Manifestations: A Scoping Review

Zheng¹

2023

Dermatology

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Background: Dupilumab is the first approved IL-4Rα inhibitor for the treatment of atopic dermatitis (AD) at present with good efficacy and safety. However, there have been several reports of psoriasis and psoriasiform manifestations occurring after dupilumab therapy in recent years, showing a new paradoxical cutaneous reaction associated with biologics. Summary: This is a scoping review in order to summarize the demographics and epidemiology, clinical manifestations, diagnosis, potential pathogenesis, and promising management of dupilumab-associated psoriasis and psoriasiform manifestations (DAPs/PsM). Key Message: The present review suggests that DAPs/PsM may occur in approximately 1.8-3.3% of AD patients after dupilumab therapy. In general, DAPs/PsM manifests similar clinical and histological features to classic psoriasis but not identical. T-cell polarization skewing between Th17 and Th2 spectrum may act as the core mechanism of DAPs/PsM, characterized by up-regulated IL-23/Th17 axis. Mild-to-moderate DAPs/PsM responds well to topical therapies while discontinuation of dupilumab is recommended in severe cases. Currently, JAK inhibitors and the combination of dupilumab with other biologics are considered as potential treatments for concurrent AD and psoriasis. Future researches are needed to clarify the detailed mechanism of this phenomenon in order to seek more effective management and prevention.

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A case of dupilumab‐induced reverse psoriasis in a patient with atopic dermatitis

Cited by 8 publications

References 8 publications

Allergic Contact Cell-Mediated Hypersensitivity in Psoriasis: A Narrative Minireview

Allergic Contact Cell-Mediated Hypersensitivity in Psoriasis: A Narrative Minireview

Application of JAK inhibitors in paradoxical reaction through immune-related dermatoses

Dupilumab-Associated Psoriasis and Psoriasiform Manifestations: A Scoping Review

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