Tumor Necrosis Factor-associated Palmoplantar Pustular Psoriasis Treated with Interleukin 6 Blocker

Younis, Said; Rimar, Doron; Slobodin, Gleb; Rosner, Itzhak

doi:10.3899/jrheum.120304

Cited by 20 publications

(10 citation statements)

References 9 publications

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“…Tofacitinib and other Janus kinase inhibitors (targeting, among the others, also the IL-6R signaling pathway) are gaining significant attention as therapeutic options in psoriasis, but their efficacy in PP is still unclear [107, 108]. Only occasional patients with generalized PP, including paradoxical anti-TNF-induced cases, have been effectively treated with the anti-IL-6 agent tocilizumab [109, 110]. A larger amount of data exists with regard to the role of IL-1 antagonist anakinra in PP, especially in cases secondary to IL36RN mutations [24, 62, 64].…”

Section: Discussionmentioning

confidence: 99%

IL-6 as a Druggable Target in Psoriasis: Focus on Pustular Variants

Saggini

Chimenti

Chiricozzi

2014

Journal of Immunology Research

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Psoriasis vulgaris (PV) is a cutaneous inflammatory disorder stemming from abnormal, persistent activation of the interleukin- (IL-)23/Th17 axis. Pustular psoriasis (PP) is a clinicopathological variant of psoriasis, histopathologically defined by the predominance of intraepidermal collections of neutrophils. Although PP pathogenesis is thought to largely follow that of (PV), recent evidences point to a more central role for IL-1, IL-36, and IL-6 in the development of PP. We review the role of IL-6 in the pathogenesis of PV and PP, focusing on its cross-talk with cytokines of the IL-23/Th17 axis. Clinical inhibitors of IL-6 signaling, including tocilizumab, have shown significant effectiveness in the treatment of several inflammatory rheumatic diseases, including rheumatoid arthritis and juvenile idiopathic arthritis; accordingly, anti-IL-6 agents may potentially represent future promising therapies for the treatment of PP.

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Section: Discussionmentioning

confidence: 99%

IL-6 as a Druggable Target in Psoriasis: Focus on Pustular Variants

Saggini

Chimenti

Chiricozzi

2014

Journal of Immunology Research

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“…Alefacept, etanercept, adalimumab and phototherapy with UVB may be considered as second-line treatments. In PPPP, various modalities have shown success, including anti-IL-6 agent tocilizumab, 85,86 and anti-IL-12 and IL-23 agent, ustekinumab. 53,[87][88][89] GMA may also be effective.…”

Section: Localized Pustular Psoriasismentioning

confidence: 99%

Generalized pustular psoriasis: a review and update on treatment

Hoegler

John

Handler

et al. 2018

Acad Dermatol Venereol

160

193

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Generalized pustular psoriasis (GPP) is a subtype of pustular psoriasis characterized by painful and occasionally disfiguring cutaneous manifestations with sepsis-like systemic symptoms. Affecting any age and race, GPP can occur with other forms of psoriasis or by itself. Stimuli for flares include medications, infections and environmental triggers. The interleukin family and caspase recruitment domain family have been implicated in its pathogenesis. Other forms of pustular psoriasis include impetigo herpetiformis, palmoplantar pustular psoriasis, annular pustular psoriasis and acrodermatitis continua of Hallopeau. Treatment is not well established, but includes the use of retinoids, methotrexate, cyclosporine, corticosteroids, TNF-alpha inhibitors, topical therapy and phototherapy. The use of TNF-alpha inhibitors may result in the formation of antidrug antibodies and should be administered with methotrexate.

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“…A literature search revealed two cases of PPP induced by TNF‐α inhibitors, with complete resolution with tocilizumab, and one case of PPP after use of rituximab, which improved with topical coal tar/salicylic acid and steroid …”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] Another popular theory is that rituximab can induce autoimmune phenomena, one of the manifestations of which could be immune-related skin lesions such as psoriasis. 7 A literature search revealed two cases of PPP induced by TNF-a inhibitors, with complete resolution with tocilizumab, 8,9 and one case of PPP after use of rituximab, which improved with topical coal tar/salicylic acid and steroid. 10 Il-6 is produced by keratinocytes, fibroblasts and vascular endothelial cells.…”

Section: Discussionmentioning

confidence: 99%

A case of tumour necrosis factor-α inhibitor- and rituximab-induced plantar pustular psoriasis that completely resolved with tocilizumab

2014

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Rituximab, a chimeric B-cell-depleting monoclonal antibody, is a well-established therapy for rheumatoid arthritis. It is emerging that classical psoriatic lesions and plantar pustular psoriasis (PPP) are cutaneous side-effects of this drug. Antitumour necrosis factor (anti-TNF) therapies have multiple documented side-effects including PPP and psoriasis. We report a patient who has rheumatoid arthritis, who failed on anti-TNF therapies and then was commenced on rituximab. Subsequently she developed localized PPP. Due to deterioration of her joint disease she was switched to the interleukin-6 blocker tocilizumab, and the PPP resolved.

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Tumor Necrosis Factor-associated Palmoplantar Pustular Psoriasis Treated with Interleukin 6 Blocker

Cited by 20 publications

References 9 publications

IL-6 as a Druggable Target in Psoriasis: Focus on Pustular Variants

IL-6 as a Druggable Target in Psoriasis: Focus on Pustular Variants

Generalized pustular psoriasis: a review and update on treatment

A case of tumour necrosis factor-α inhibitor- and rituximab-induced plantar pustular psoriasis that completely resolved with tocilizumab

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