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Psoriasiform eruptions on the trunk and the elbow in both patients (A,B,D,E), dermoscopic image showing pinpoint bleeding (C,F).
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Background
Atopic dermatitis (AD) is a chronic recurrent inflammatory disease, and dupilumab, a human monoclonal antibody, is the firstly approved biological drug for AD. Psoriasiform erythema (PE) during dupilumab treatment in adults has been reported. This study describes the risk of PE in children after initiation of dupilumab treatment.
Object...
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Rationale:
Eczematous eruption is an increasingly recognized form of drug-related eruption, typically reported in association with interleukin 17 (IL-17)A inhibitors. However, severe paradoxical eczematous eruption due to IL-17A inhibitors has been rarely reported. Herein, we reported a case of a man with severe psoriasis with erythematous scaly p...
Citations
... Ali et al. reported cases of twin dupilumab-induced psoriasiform eruption that resolved with baricitinib, as in our case. 4 In the paper, mRNA (RNA-FISH) cytokines gene expression in the lesional skin biopsy specimens showed a significantly high concentration of IL-17A. Blood tests revealed a high concentration of IgE and eosinophils, and cytokines detection in blood showed IL-5, IL-6 and IL-17 in one patient; however, only IL-5 in another patient. ...
... The authors supposed that the balance might shift towards Th1/Th17 predominance, and psoriasis develops by suppressing skewed Th2 activation in patients with AD although the heterogeneity exists. 4 This is the rare report of psoriasis-like eruption triggered by dupilumab and resolved by baricitinib treatment, which also yielded good control of AD. Baricitinib, a JAK1/2 inhibitor, could be a favourable option for patients with AD who develop dupilumab-induced psoriasis-like eruption. ...
Dupilumab is a humanized monoclonal antibody against the interleukin (IL)‐4 receptor alpha chain that inhibits IL‐4 and IL‐13 signalling. It is one of the systemic treatments for patients with moderate‐to‐severe atopic dermatitis (AD), which provides favourable safety and efficacy. We report a case of psoriasis‐like eruption induced by dupilumab as an adverse effect in a patient with AD, immediately remitted after switching to baricitinib, which inhibits JAK1/2. Moreover, the atopic skin lesion also simultaneously went into remission upon baricitinib treatment. Baricitinib could be a favourable option for patients with AD who develop dupilumab‐induced psoriasis‐like eruption.
... The larger spectrum of activity of JAK inhibitors could justify their effectiveness in cases of overlapping features of psoriasis and atopic dermatitis. In particular, baricitinib [36,40] and upadacitinib [32,36] have been successfully used in these cases and delgocitinib ointment has been reported as effective [25]. However, the efficacy of these molecules in dupilumab-induced psoriasis has not been systematically investigated yet. ...
... Med. 2023, 12, x FOR PEER REVIEW 13 of 16 particular, baricitinib [36,40] and upadacitinib [32,36] have been successfully used in these cases and delgocitinib ointment has been reported as effective [25]. However, the efficacy of these molecules in dupilumab-induced psoriasis has not been systematically investigated yet. ...
Atopic dermatitis and psoriasis are traditionally considered diseases that cannot coexist, since they are described as the result of the activation of opposing inflammatory pathways. However, this belief has been debunked, and numerous cases of psoriasis induced by dupilumab, a biologic treatment for atopic dermatitis, have been reported. We report three cases of dupilumab-induced psoriasis and we present a literature review including cases of “de novo” psoriasis and of the relapse of psoriasis that occurred during treatment with dupilumab. In total, 39 publications met the inclusion criteria, including 112 AD patients, 101 of whom developed “de novo” psoriasis, and 11 with a flare of pre-existent psoriasis. In the first group, patients more frequently developed plaque psoriasis on the scalp and extremities, after an average latency period from the initiation of dupilumab of 5 months. In the second group, the incidence of dupilumab-induced relapses of psoriasis was 43%, after an average of 4 months since the first administration. The most common psoriasis type was plaque psoriasis, with the involvement of the scalp and upper extremities. Dupilumab was interrupted in 38% of patients with “de novo” psoriasis and in 50% of relapsed patients, leading, in most cases, to an improvement of psoriasis. In conclusion, atopic dermatitis and psoriasis can definitely co-exist, and biologic drugs used to treat the former can promote the latter. It is thus crucial to perform a careful personal and familiar anamnesis before prescribing any biologic treatment. Moreover, a study of cytokine expression and blood proteomic markers could be considered in these patients.
... A case of Asian (Chinese) teenage twin brothers with a long history of AD since childhood has been reported. The twin brothers developed psoriasiform erythemas under the treatment of dupilumab, with a high IL-17A expression [36]. This result may indicate that Asian and pediatric patients have a higher possibility to develop DAPs/PsM because of the intrinsic Th17 component. ...
... Currently, Janus Kinase (JAK) inhibitors are considered as potential treatments for patients presenting both AD and psoriasis, providing new ideas for the treatment of refractory DAPs/PsM [38]. Baricitinib, an oral selective JAK1 and JAK2 inhibitors, was applied to two seventeen-year-old teenagers with DAPs/PsM and showed a significant reduction in skin lesions [36]. Upadacitinib (selective JAK 1 inhibitor), was also reported in treating DAPs/PsM, resulting complete remission of both psoriasiform eruptions and AD [33]. ...
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.
... Inhibition of the Th2 pathway by dupilumab hypothetically results in a shift toward a Th1-dominant response (11). An increasing number of patients report Th1-mediated skin disorders, such as exacerbated Th1-dependent allergic contact dermatitis (ACD), after the initiation of dupilumab (12). ...
Dupilumab was the first biological medication licensed to treat atopic dermatitis (AD), and it has shown remarkable effectiveness and safety in the treatment of moderate-to-severe atopic dermatitis. There are limited drug-related adverse events associated with dupilumab in atopic dermatitis (AD) treatment. Here, we present two cases of local Staphylococcus aureus infection during the treatment of atopic dermatitis with dupilumab.
To date, most studies to identify biomarkers associated with response to the anti-interleukin 5 agent, mepolizumab, and to the anti-immunoglobulin E agent, omalizumab have focused on clinically available biomarkers, such as the peripheral blood eosinophil counts (BEC) and total immunoglobulin E (IgE). However, these biomarkers often have low predictive accuracy, with many patients with eosinophilic or allergic asthma failing to demonstrate clinical response to mepolizumab or omalizumab respectively. In this study, we evaluated the association of baseline pre-biologic plasma levels of 26 cytokines and chemokines, including T-helper 1 (Th1)-, Th2-, Th17-related cytokines, and their ratios with subsequent clinical response to mepolizumab or omalizumab. We defined clinical response as a reduction in the baseline annual exacerbation rate by half or more over the one-year period following initiation of the biologic. Baseline levels of plasma IL-13 were differentially elevated in responders versus non-responders to mepolizumab and plasma CXCL10 levels were differentially elevated in responders to omalizumab. The ratio of IL-13/TNF-α had the best sensitivity and specificity in predicting response to mepolizumab and CXCL10/CCL17 to omalizumab, and these performed better as predictive biomarkers of response than BEC and IgE. Cytokines and chemokines associated with airway eosinophilia, allergic inflammation, or Th2 inflammation, such as IL-13 and CXCL10, may be better predictors of clinical response to mepolizumab and omalizumab, than IL-5 or IgE, the targets of mepolizumab and omalizumab.
Atopic dermatitis (AD) and psoriasis belong to the most common inflammatory dermatoses that we treat in everyday clinical practice. AD manifests in more than 70% of cases before the age of 5 years. Approximately one-third of psoriasis patients report on onset of disease in the first two decades of life. Here, we are going to review both disorders in the light of pediatric dermatology. We are going to discuss selected subtypes and present clues for further examination with respect to the differential diagnoses and comorbidities. The article provides insight into current therapeutic developments that are relevant for the treatment of children and adolescents.
Background
Atopic dermatitis (AD) and psoriasis vulgaris (PV) are almost mutually exclusive diseases with different immune polarizations, mechanisms and therapeutic targets. Switches to the other disease (“Flip‐Flop” [FF] phenomenon) can occur with or without systemic treatment and are often referred to as paradoxical reactions under biological therapy.
Methods
The objective was to develop a diagnostic algorithm by combining clinical criteria of AD and PV to identify FF patients. The algorithm was prospectively validated in patients enrolled in the CK‐CARE registry in Bonn, Germany. Afterward, algorithm refinements were implemented based on machine learning.
Results
Three hundred adult Caucasian patients were included in the validation study (n = 238 with AD, n = 49 with PV, n = 13 with FF; mean age 41.2 years; n = 161 [53.7%] female). The total FF scores of the PV and AD groups differed significantly from the FF group in the validation data (p < .001). The predictive mean generalized Youden‐Index of the initial model was 78.9% [95% confidence interval 72.0%–85.6%] and the accuracy was 89.7%. Disease group‐specific sensitivity was 100% (FF), 95.0% (AD), and 61.2% (PV). The specificity was 89.2% (FF), 100% (AD), and 100% (PV), respectively.
Conclusion
The FF algorithm represents the first validated tool to identify FF patients.
Atopic dermatitis (AD) and psoriasis are both chronic recurrent inflammatory skin diseases. However, research on AD and psoriasis co-morbidity is still in early stages and limited to clinical manifestations. In this study, we studied the role of autophagy-related genes in AD and psoriasis by used integrated bioinformatics methods. We obtained differentially expressed genes (DEGs) for psoriasis and AD by analyzing the datasets GSE14905(psoriasis) and GSE32924(atopic dermatitis). We further identified autophagy-related DEGs by intersecting above-obtained DEGs with autophagy-related genes. Then we performed Gene Ontology (GO), Kyoto Encyclopedia Genes and Genomes (KEGG) and Gene Set Enrichment Analysis (GSEA). And hub genes were identified by constructing protein-protein interaction (PPI) networks. Finally, we conducted ROC validation of hub genes and explored the correlation of hub genes with other molecules and immune cells in atopic dermatitis and psoriasis. Finally, we concluded that the 13 autophagy-related genes are involved in the pathogenesis and progression of AD and psoriasis by regulating cell cycle, cellular components eradication and drug metabolisms, and could predict the onset and severity of diseases.
