Atopic Dermatitis-like Eruption Induced by Two Different Biologics in a Patient with Psoriatic Arthritis

Abe, Fumihito; Mitsuyama, Shinji; Nagao, Eri; Kimura, Masaaki; Higuchi, Tetsuya

doi:10.2340/00015555-3321

Cited by 8 publications

(11 citation statements)

References 7 publications

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“…Similarly, there have been some reports that patients with psoriasis developed AD after the treatment of biologics [43, 44]. Some authors proposed that inhibition of the Th2 pathway may result in a shift toward the Th1 inflammatory pathway and vice versa [41, 44]. In the current study, the sensitivity analysis excluding psoriasis patients with prior use of biologics showed similar results in the association between psoriasis and risk of AD.…”

Section: Discussionsupporting

confidence: 77%

“…Several case reports showed that patients with AD developed psoriasis after dupilumab [38-42]. Similarly, there have been some reports that patients with psoriasis developed AD after the treatment of biologics [43, 44]. Some authors proposed that inhibition of the Th2 pathway may result in a shift toward the Th1 inflammatory pathway and vice versa [41, 44].…”

Section: Discussionmentioning

confidence: 99%

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Bidirectional Association between Psoriasis and Atopic Dermatitis: A Nationwide Population-Based Cohort Study

et al. 2021

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Background: There have been some reports on the coexistence of psoriasis and atopic dermatitis; however, the longitudinal relationship between these two diseases remains unclear. Objective: This study aimed to investigate the bidirectional association between psoriasis and atopic dermatitis. Methods: This cohort study recruited patients from the National Health Insurance Research Database in Taiwan. We included 8,206 patients with psoriasis and 32,824 matched controls to assess the risk of atopic dermatitis and 25,743 patients with atopic dermatitis and 102,972 matched controls to assess the risk of psoriasis. Cox regression model was used for the analyses. Results: After adjusting for potential confounders, patients with psoriasis had a higher risk of atopic dermatitis (adjusted hazard ratio [aHR] 13.01; 95% CI 10.23–16.56) than the controls. Patients with atopic dermatitis had a higher risk of psoriasis (aHR 10.37; 95% CI 6.85–15.69) than the controls. Stratified analyses revealed similar results in both sexes and all age groups. Conclusion: Our study demonstrated a bidirectional association between psoriasis and atopic dermatitis, suggesting that psoriasis and atopic dermatitis are not mutually exclusive and may share some biological mechanisms.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Bidirectional Association between Psoriasis and Atopic Dermatitis: A Nationwide Population-Based Cohort Study

et al. 2021

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“… 1 , 6 Atopic dermatitis has been shown to be precipitated by biologics used to treat psoriasis. 7 – 9 …”

Section: Discussionmentioning

confidence: 99%

“…1,6 Atopic dermatitis has been shown to be precipitated by biologics used to treat psoriasis. [7][8][9] On the other hand, dupilumab is a humanized IgG4 monoclonal antibody binding the alpha subunit of the IL-4 receptor, which has a close association with Th2 differentiation. Having affinity to both IL-4 receptor complexes, it can inhibit IL-4 (type 1 and type 2 specific) as well as IL-13 (type 2 specific).…”

Section: Discussionmentioning

confidence: 99%

Psoriasis appearing after dupilumab therapy in atopic dermatitis: A case report

Kim

Yeung

2020

SAGE Open Medical Case Reports

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A 36-year-old Caucasian female with a long history of atopic dermatitis presented with multiple flares eventually leading to dupilumab therapy. Five months into the dupilumab therapy, she presented with well-demarcated erythematous plaques with silvery scale resembling psoriasis on her knees and shins (body surface area 2%, Psoriasis Area Severity Index 1.6, Investigator’ Global Assessment 2). Biopsies were taken to confirm the diagnosis of classic psoriasis. Dupilumab was continued for another month while using clobetasol 0.05% ointment. The patient reported poor adherence to clobetasol therapy, and the lesions persisted. When dupilumab was discontinued, her psoriasis resolved over 6 weeks, but her atopic dermatitis returned. Dupilumab was restarted for atopic dermatitis management, and her psoriasis returned. There appears to be a rare causal association between dupilumab and psoriasis in this case. The mechanism of the drug reaction is yet to be discovered.

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“…Accordingly, inhibition of IL-17 may be a trigger to induce AD-like eruptions. 10 At the same time, one patient with a new onset AD, was under treatment with guselkumab, that inhibiting IL-23, reduces the differentiation toward Th17 cell line and IL-17 levels, impairing also in this case (as well as for ustekinumab) the skin barrier function and inducing AD and/or eczematous-like eruptions. 10 Finally, two psoriatic patients which were under treatment with adalimumab (anti-TNF-α) developed AD.…”

Section: Discussionmentioning

confidence: 99%

New onset atopic dermatitis and psoriasis in the same patients under biologic treatments: The role of systemic treatments as a possible trigger

Paolino

Nicola

Brianti

et al. 2022

Dermatologic Therapy

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Atopic dermatitis (AD) and psoriasis (PsO) are among the most common diseases in the daily clinical practice. Usually, AD and PsO are reported as two diseases that cannot coexist in the same patient because this requires the activation of opposing inflammatory pathways. Anyway, some reports highlight how AD and PsO may coexist in the same patient or develop consequently. In this short report we collected 12 patients that developed new AD or PsO. Among them, eight patients (n = 8; 3M:5F) with a previous diagnosis of PsO, developed subsequently an AD with a mean time of onset of 71.5 months. Out of eight patients, four patients where in treatment with ustekinumab, one with ixekizumab, two with adalimumab, and one with guselkumab. All new onset AD have been treated with topical medicaments, except one case that performed dupilumab. Contrariwise, four patients with a baseline AD developed a PsO with a mean time of onset of 25 months. Two AD patients were under dupilumab treatment, while the other two patients performed only topical treatments. All patients showed an improvement of the new onset PsO with topical treatment only. This report highlights how AD and PsO are not mutually exclusive diseases. The mechanisms by which AD patients develop PsO or psoriatic patients develop AD are still not very clear; some triggers can promote these processes, such as systemic therapies. Therefore, clinicians should carefully evaluate any changes in these patients, in order to reach a correct diagnosis and carry out a relative treatment.

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Atopic Dermatitis-like Eruption Induced by Two Different Biologics in a Patient with Psoriatic Arthritis

Cited by 8 publications

References 7 publications

Bidirectional Association between Psoriasis and Atopic Dermatitis: A Nationwide Population-Based Cohort Study

Bidirectional Association between Psoriasis and Atopic Dermatitis: A Nationwide Population-Based Cohort Study

Psoriasis appearing after dupilumab therapy in atopic dermatitis: A case report

New onset atopic dermatitis and psoriasis in the same patients under biologic treatments: The role of systemic treatments as a possible trigger

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