Intradermal antigen tests and the Koebner phenomenon in psoriasis

Doğan, Bilal; Harmanyeri, Yavuz

doi:10.1046/j.1365-4362.1997.00164.x

Cited by 17 publications

(15 citation statements)

References 5 publications

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“…These results were corroborated by the observation that intradermal application of staphylococcal protein A solution produced a more intense erythematous reaction in psoriasis than in atopic dermatitis patients or in healthy controls [11]. Yet, other researchers have reported [12] equivalent cutaneous cellular immune reactions in psoriasis patients when compared to patients suffering from skin diseases other than psoriasis, after intradermal challenge with a series of ‘environmental’ antigens, including PPD. Moreover, even depressed reactivity to PPD has been reported in a small series of patients with guttate psoriasis as compared to healthy controls [13].…”

Section: Introductionmentioning

confidence: 68%

“…Additionally, among the dermatology patients, the psoriasis cohort presents with even larger TST reactions than patients with other skin pathologies leading to hospitalization. Compared to previous corresponding reports in the literature, in this study the number of patients included was notably larger and TST was evaluated per se instead of the ability of intradermal PPD to induce an isomorphic (Köbner) reaction [10, 12]. …”

Section: Discussionmentioning

confidence: 99%

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Tuberculin Skin Test Overestimates Tuberculosis Hypersensitivity in Adult Patients with Psoriasis

et al. 2009

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Background: Tuberculin skin testing (TST) is still the reference method for the diagnosis of latent tuberculosis infection (LTBI). Objective: To evaluate the effect of psoriasis on TST. Methods: Comparison of TST results of consecutive dermatology (n = 91) and internal medicine (n = 615) inpatients. TST was uniformly ordered, performed and evaluated according to the Mantoux method using purified protein derivative. Results: (a) Significantly larger TST indurations were measured in dermatology (median: 7 mm) compared to internal medicine inpatients (median: <1 mm; p < 0.0001). More dermatology inpatients showed ‘positive’ (>5 mm) and ‘strongly positive’ (≥15 mm) TST results (53 vs. 29% and 22 vs. 13%, respectively). (b) Among dermatology inpatients, the TST reactions were significantly larger (p < 0.01) in psoriatics (n = 28) compared to the remaining patients (n = 63). (c) In psoriatics, the TST correlated positively with the psoriasis area and severity index score (p = 0.015). Conclusion: Overt psoriasis is associated with increased TST measurements. This observation is suggestive of a possible overtreatment of these patients for LTBI.

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Section: Introductionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Tuberculin Skin Test Overestimates Tuberculosis Hypersensitivity in Adult Patients with Psoriasis

et al. 2009

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“…Several studies have investigated the cell-mediated reactivify status of psoriasis patients. Tsiouri et al (17) described exacerbated TST responses, while other in vitro and/or in vivo studies found either depressed or normal reactivify (18)(19)(20)(21). The reasons for such discrepancies are unclear, but may be related to differences in severify of the psoriasis, immunosuppressive treatment, and immunological tests employed.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of an IFN-gamma Assay in the Diagnosis of Latent Tuberculosis in Patients with Psoriasis in a Highly Endemic Setting

Lima¹,

Lima²,

Lorena³

et al. 2011

Acta Derm Venerol

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Screening for latent tuberculosis infection is mandatory before starting anti-tumour necrosis factor treatments, but its diagnosis still poses a challenge. While studies performed in developed countries have demonstrated superior performance of T-cell based interferon-γ release assay (IGRA) compared with the tuberculin skin test, there is a debate about whether this holds true in tuberculosis endemic areas. The performance of an IGRA kit T-SPOT.TB was evaluated in 33 moderate-to-severe untreated psoriasis patients and, as controls, 30 patients with common dermatological diseases at a tuberculosis highly endemic setting. The frequency of positive tuberculin skin test responses and induration size in controls were higher than in psoriasis patients (53% vs. 18% and 9.3 ± 1.4 vs. 2.6 ± 0.7 mm, respectively, p < 0.001). In contrast, the frequency of positive response and mean number of spots elicited with the T-SPOT.TB test were not significantly different between patients and controls (47% vs. 43% and 14.7 ± 3.2 vs. 20.5 ± 3.1 spots/well, respectively). The two tests presented good agreement in the control, but not the psoriasis group (κ values of 0.625 and 0.375, respectively). Thus, in a highly tuberculosis-endemic setting the T-SPOT.TB test was superior to the tuberculin skin test in diagnosing latent tuberculosis infection in psoriasis, probably because the immune dysregulation of psoriasis shows a lower interference in the in vitro test.

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“…Moreover, important immunologic mechanisms take place in even apparently healthy skin of psoriatic patients; the proinflammatory state can lead to an overreaction to antigenic triggers [67]. Another factor that may lead to false-positive results is the Koebner phenomenon (development of psoriatic lesions at the site of trauma), reported after intradermal injection of purified protein derivative (PPD) in psoriatic patients [68]. In contrast, psoriatic patients with negative TST results and positive QFT-G results have been reported [69–71].…”

Section: Discussionmentioning

confidence: 99%

Psoriasis, Anti-Tumor Necrosis Factor Therapy, and Tuberculosis: Report of Three Challenging Cases and Literature Review

Solovan

Chiticariu

2013

Infect Dis Ther

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IntroductionThe era of biologic therapies has provided new options for the treatment of chronic plaque psoriasis. However, safety concerns have led to intensive screening and monitoring of patients receiving anti-tumor necrosis factor alpha (anti-TNF-alpha) agents.MethodsThe authors describe the cases of three patients with moderate to severe psoriasis treated with anti-TNF agents, with challenging diagnostic and treatment aspects regarding tuberculosis (TB) infection, a serious adverse event associated with this type of treatment. The cases are discussed in the context of a comprehensive literature review describing the risk of TB associated with the use of TNF inhibitors. A critical review of the clinical trials that have tested the safety of these agents is also presented.ResultsOne patient, who tested negatively for latent TB infection (LTBI) during screening, developed active TB under adalimumab therapy. For two other patients the diagnosis and management of LTBI in relation to anti-TNF therapy represented a challenge. Although clinical trials involving the use of anti-TNF therapy for psoriasis haven’t demonstrated a high TB incidence, active TB is continuously reported in association with this treatment.ConclusionsFindings from clinical practice and the scientific literature indicate that anti-TNF therapies are associated with an increased risk of TB, and close monitoring of patients is needed.

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Intradermal antigen tests and the Koebner phenomenon in psoriasis

Cited by 17 publications

References 5 publications

Tuberculin Skin Test Overestimates Tuberculosis Hypersensitivity in Adult Patients with Psoriasis

Tuberculin Skin Test Overestimates Tuberculosis Hypersensitivity in Adult Patients with Psoriasis

Evaluation of an IFN-gamma Assay in the Diagnosis of Latent Tuberculosis in Patients with Psoriasis in a Highly Endemic Setting

Psoriasis, Anti-Tumor Necrosis Factor Therapy, and Tuberculosis: Report of Three Challenging Cases and Literature Review

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