Synthetic antimalarial drugs and the triggering of psoriasis – do we need disease‐specific guidelines for the management of patients with psoriasis at risk of malaria?

Gravani, Agoritsa; Gaitanis, Georgios; Zioga, Aikaterini; Bassukas, Ioannis D.

doi:10.1111/ijd.12231

Cited by 21 publications

(13 citation statements)

References 12 publications

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“… 127 It is reported that induction or exacerbation of psoriasis is observed in lichen planopilaris (a 40-year-old female) and psoriatic arthritic (a 37-year-old primigravida) patients treated with hydroxychloroquine. 128 An acute gluteal abscess after an injection of chloroquine has also been reported. 129 Acute generalized exanthematous pustulosis has been reported in Canada as an adverse reaction to hydroxychloroquine.…”

Section: Adverse Effectsmentioning

confidence: 96%

Chloroquine analogues in drug discovery: new directions of uses, mechanisms of actions and toxic manifestations from malaria to multifarious diseases

Al‐Bari

2015

Journal of Antimicrobial Chemotherapy

377

306

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Antimalarial drugs (e.g. chloroquine and its close structural analogues) were developed primarily to treat malaria; however, they are beneficial for many dermatological, immunological, rheumatological and severe infectious diseases, for which they are used mostly today. Chloroquine and hydroxychloroquine, two of the most fascinating drugs developed in the last 50 years, are increasingly recognized for their effectiveness in myriad non-malarial diseases. In advanced research, chloroquine and hydroxychloroquine have been shown to have various immunomodulatory and immunosuppressive effects, and currently have established roles in the management of rheumatic diseases, lupus erythematosus (different forms) and skin diseases, and in the treatment of different forms of cancer. Recently, chloroquine analogues have also been found to have metabolic, cardiovascular, antithrombotic and antineoplastic effects. This review is concerned with the lysosomotropic, anti-inflammatory and immunomodulatory mechanisms of chloroquine, hydroxychloroquine, quinacrine and related analogues, and the current evidence for both their beneficial effects and potential adverse manifestations in various diseases.

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Section: Adverse Effectsmentioning

confidence: 96%

Chloroquine analogues in drug discovery: new directions of uses, mechanisms of actions and toxic manifestations from malaria to multifarious diseases

Al‐Bari

2015

Journal of Antimicrobial Chemotherapy

377

306

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“… 10 Hydroxychloroquine and other synthetic antimalarial drugs may induce psoriasis by interfering with the integrity of the epidermal barrier. 11 Proposed mechanisms include inhibition of epidermal transglutaminase enzymes or interfering with cholesterol metabolism, both of which are important for the structure of the epidermal barrier. 11 The rash occurs quickly, typically within 4–12 weeks after drug introduction.…”

Section: Discussionmentioning

confidence: 99%

“… 11 Proposed mechanisms include inhibition of epidermal transglutaminase enzymes or interfering with cholesterol metabolism, both of which are important for the structure of the epidermal barrier. 11 The rash occurs quickly, typically within 4–12 weeks after drug introduction. 2 Thalidomide was reported to induce psoriasis in 1 case report, with disease induction within 2 weeks.…”

Section: Discussionmentioning

confidence: 99%

Development of Drug-Induced Inverse Psoriasis in a Patient with Crohnʼs Disease

Darwin

Deshpande

Lev‐Tov

2018

ACG Case Reports Journal

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Crohn’s disease is difficult to manage and often requires multiple medications. While these drugs vastly improve quality of life, physicians must monitor for adverse events. We report a case of a flare of inverse psoriasis after 15 months of treatment with ustekinumab. This is the third reported case of a flare of drug-induced psoriasis with ustekinumab, and it is the first reported case with an inverse presentation; however, the clinical picture is confounded by concomitant use of hydroxychloroquine. Inverse psoriasis is a rare variant of drug-induced psoriasis of which physicians must be cognizant while treating patients with Crohn’s disease.

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“…37 , 38 Furthermore, there have been cases reported of psoriasis exacerbation with the use of hydroxychloroquine as immunomodulating treatment for lichen planopilaris and psoriatic arthritis. 39 Rarely, these antimalarial drugs are linked to induction of psoriasis. 40 The latency period of psoriasis exacerbation is usually between 4 and 12 weeks.…”

Section: Traditionally Reported Drug-associationsmentioning

confidence: 99%

Drug-induced psoriasis: clinical perspectives

Balak¹,

Hajdarbegovic²

2017

PTT

101

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Exposure to certain drugs can elicit an induction or exacerbation of psoriasis. Although well-conducted systematic studies on drug-related psoriasis are mostly lacking, traditionally strong associations have been documented for beta-blockers, lithium, antimalarial drugs such as (hydroxy)chloroquine, interferons, imiquimod, and terbinafine. More recently, new associations have been reported for monoclonal antibody- and small-molecule-based targeted therapies used for oncological and immunological indications, such as tumor necrosis factor-alpha antagonists and anti-programmed cell death protein 1 immune checkpoint inhibitors. Recognizing potential drug-related psoriasis is of clinical relevance to allow an optimal management of psoriasis. However, in clinical practice, identifying medication-related exacerbations and induction of psoriasis can be challenging. The clinical and histopathological features of drug-provoked psoriasis may differ little from that of “classical” nondrug-related forms of psoriasis. In addition, the latency period between start of the medication and onset of psoriasis can be significantly long for some drugs. Assessment of the Naranjo adverse drug reaction probability scale could be used as a practical tool to better differentiate drug-related psoriasis. The first step in the management of drug-related psoriasis is cessation and replacement of the offending drug when deemed clinically possible. However, the induced psoriasis skin lesions may persist after treatment withdrawal. Additional skin-directed treatment options for drug-related psoriasis follows the conventional psoriasis treatment guidelines and includes topical steroids and vitamin D analogs, ultraviolet phototherapy, systemic treatments, such as acitretin, methotrexate, and fumaric acid esters, and biological treatments.

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Synthetic antimalarial drugs and the triggering of psoriasis – do we need disease‐specific guidelines for the management of patients with psoriasis at risk of malaria?

Cited by 21 publications

References 12 publications

Chloroquine analogues in drug discovery: new directions of uses, mechanisms of actions and toxic manifestations from malaria to multifarious diseases

Chloroquine analogues in drug discovery: new directions of uses, mechanisms of actions and toxic manifestations from malaria to multifarious diseases

Development of Drug-Induced Inverse Psoriasis in a Patient with Crohnʼs Disease

Drug-induced psoriasis: clinical perspectives

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