晚期肺癌患者应用PD-1抑制剂致银屑病样药疹一例并文献复习

报道1例75岁男性晚期肺癌患者应用PD-1抑制剂(替雷利珠单抗)免疫治疗后引起银屑病样药疹并进行文献复习。患者在替雷利珠单抗治疗1周后出现由甲床开始,逐渐累及四肢、躯干的鳞屑性皮疹,伴有瘙痒及双下肢肿胀。皮损组织病理未见银屑病特征性表现。经治疗后患者无新发皮疹,原有皮疹明显消退,鳞屑脱落。诊断:银屑病样药疹,给予糖皮质激素等治疗后,患者逐渐好转。     

A型肉毒素治疗银屑病一例并文献复习

有文献报道A型肉毒素治疗顽固性斑块型银屑病和反转型银屑病效果较好。本文报道A型肉毒素治疗斑块型银屑病患者一例并对相关文献进行复习。患者右小腿外侧皮损作为靶皮损（PASI=7分）,注射A型肉毒素,臀部皮损（PASI=6分）为对照靶皮损,无特殊治疗。A型肉毒素注射1个月后回访,右小腿皮疹明显好转,PASI=1分;臀部对照皮损,无明显好转,PASI=5分。     

线状银屑病一例

42岁男性患者,右前臂淡红色斑块、鳞屑伴痒痛1个月,皮损沿Blaschko线排列。5年前相同部位及2年前项部均曾出现过类似皮损。结合临床表现、病史及皮肤组织病理检查,诊断为线状银屑病。     

PD-1抑制剂（卡瑞利珠单抗）致反应性毛细血管增生症三例并文献复习

报道3例实体肿瘤患者经新型PD-1抑制剂（卡瑞利珠单抗）治疗后引起反应性毛细血管增生症并对既往文献进行复习。3例实体肿瘤患者在首次卡瑞利珠单抗治疗后于头颈、四肢或躯干逐渐出现红痣型、珍珠型或桑葚型的血管增生物，皮肤镜检查发现红白均质背景下多个小的边界清晰的红色腔隙，散在分布于皮损区域内。诊断：反应性毛细血管增生症。     

免疫检查点抑制剂相关Stevens-Johnson综合征一例

本文报道1例经13程替雷利珠单抗治疗肺腺癌的37岁男性患者,使用伏美替尼1个月后出现Stevens-Johnson综合征(SJS),自行服用安罗替尼1天后加重,诊断为SJS,CTCAE分级3级,经激素冲击治疗后1个月内恢复。免疫检查点抑制剂、表皮生长因子抑制剂、多激酶抑制剂均可以引起角质形成细胞凋亡,导致SJS/TEN,其中免疫治疗导致的SJS/TEN病情重、死亡率高,免疫治疗后使用靶向药物会提高严重皮肤不良事件的发生率。在免疫治疗后引入靶向治疗,脱敏可能是必要的。     

依奇珠单抗治疗儿童脓疱型银屑病一例

有文献报道脓疱型银屑病的发生和发展与IL-17A有关,使用IL-17A拮抗剂可一定程度上逆转银屑病的分子生物学过程,从而改善患者的临床症状。目前有依奇珠单抗治疗成年人脓疱型银屑病的报道,但尚未有其治疗儿童脓疱型银屑病的报道,本文报道依奇珠单抗成功治疗12岁脓疱型银屑病患儿一例。     

依奇珠单抗治疗银屑病短期疗效的单中心病例回顾性研究

目的评估依奇珠单抗在真实世界中治疗银屑病患者的短期疗效, 探讨影响依奇珠单抗短期疗效的因素。方法回顾性收集2019年11月至2021年9月湘雅医院皮肤科收治接受依奇珠单抗治疗银屑病患者的基线特征和短期疗效评估结果。患者基线特征采用描述性分析方法, 连续变量以M(Q1, Q3)描述, 分类变量以百分比描述。依奇珠单抗治疗前后疾病严重程度的比较采用Wilcoxon符号秩和检验或配对McNemar检验。采用多因素logistic回归分析探索依奇珠单抗治疗4周的疗效影响因素。结果共纳入118例银屑病患者, 男94例、女24例, 年龄M(Q1, Q3)为43.4(32.5, 53.0)岁, 以斑块状寻常型银屑病(99/118, 83.9%)和重度银屑病(72/105, 68.6%)为主, 皮损主要位于头皮(59/116, 50.9%)。49例接受依奇珠单抗治疗2周后, 27例(55.1%)银屑病皮损面积和严重程度指数(PASI)评分改善50%(PASI50);治疗4周后, 分别有44例(89.8%)、30例(61.2%)、13例(26.5%)、10例(20.4%)达PASI50/75/90/10...     

司库奇尤单抗治疗七例银屑病疗效评价

目的：评价司库奇尤单抗治疗银屑病的疗效和安全性。方法：选取中重度斑块状银屑病患者及泛发性脓疱型银屑病患者，给予司库奇尤单抗,300 mg/次，0～4周每周一次，后每4周一次，并分别于治疗前、1周后、4周后、8周后记录斑块状银屑病患者的银屑病皮损面积和严重度指数(PASI)、泛发性银屑病患者银屑病症状量表(PSS)评分。结果：共治疗6例斑块状银屑病和1例脓疱型银屑病患者，所选的患者均接受至少8周的司库奇尤单抗治疗，起效时间为（1.6±0.73)天；治疗4周时，6例斑块状银屑病患者中全部达到PASI 75，3例达到PASI 90；脓疱型患者PSS评分为2。治疗8周时6例斑块状银屑病患者均达到PASI 100；脓疱型患者PSS评分为0。所有患者治疗期间均未出现严重的药物不良反应。结论：司库奇尤单抗治疗中重度银屑病起效迅速，疗效显著，不良反应少。     

成人银屑病皮炎1例报告及文献复习

报告1例银屑病皮炎。患者男,36岁。因全身反复红斑及丘疹伴瘙痒6年余,加重2个月余就诊。皮肤科检查：头皮可见较多白色鳞屑,枕后可见红色斑块;面部弥漫性红色斑片,上覆白色鳞屑,双耳可见散在痂壳;躯干及四肢散在红色斑块,部分上覆白色鳞屑,指甲部分可见点状凹陷及甲板变形。多次皮损组织病理检查均提示银屑病特征性改变。根据临床表现及皮损组织病理检查结果,最终诊断为银屑病皮炎。     

IL-12/23抑制剂乌司奴单抗在银屑病治疗中的应用

银屑病是一种免疫紊乱介导的以皮肤慢性炎症性改变为主的系统性疾病,临床表现为皮肤红斑鳞屑,可累及指(趾)甲及关节。IL-12和IL-23是参与银屑病发病的重要细胞因子,乌司奴单抗是靶向抑制IL-12和IL-23共有亚基p40的全人源单克隆抗体制剂,多项国内外随机对照临床试验结果表明,乌司奴单抗应用于中重度斑块型银屑病和关节病型银屑病的治疗可显著改善病情,提高患者生活质量,具有良好的有效性、长期稳定性和安全性。     

Challenges in sarcoidosis and sarcoid‐like reactions associated to immune checkpoint inhibitors: A narrative review apropos of a case

Sarcoidosis and sarcoid‐like reactions (SLRs) may develop in association with various malignancies, as well as in association to certain oncologic drugs, including immune checkpoint inhibitors (ICIs). We aimed to perform a narrative review with regard to the development of ICIs‐associated sarcoidosis or SLRs, and to discuss the corresponding diagnostic and therapeutic challenges raised in this scenario. Apropos of a melanoma patient developing SLRs while treated with ipilimumab and nivolumab, we searched for clinically evident, ICIs‐associated sarcoidosis or SLRs in the English literature. We recorded the oncologic characteristics, including type of malignancy and type of ICI, the phenotypic characteristics of sarcoidosis/SLRs, as well as the impact on immunotherapy. Including our patient, we identified 80 ICIs‐associated sarcoidosis or SLRs cases. Both sexes were equally affected (40 F/40 M) and the most common malignancy was melanoma (65/80, 81.3%). Concerning the oncologic treatment, there was a predilection for pembrolizumab (23/80, 28.7%), followed by the ipilimumab/nivolumab combination (21/80, 26.3%), ipilimumab (18/80, 22.5%), nivolumab (16/80, 20.0%). Although in the majority of the cases (52/80, 65.0%) there was no need for systemic prednisolone for the management of sarcoidosis, a significant proportion of patients finally discontinued ICIs treatment (44/80, 55.0%). Phenotypically, sarcoidosis and SLRs highly imitate oncologic progression posing diagnostic difficulties. A therapeutic dilemma is also raised when there is a need for systemic prednisolone, since the latter may jeopardize the therapeutic efficacy of immunotherapy. Sarcoidosis and SLRs, though rare, can present in oncologic patients treated with ICIs. Clinicians should be aware of this possibility and the related diagnostic and therapeutic challenges they have to face in this scenario.     

Flare-up of pustular psoriasis with fluoxetine: possibility of a serotoninergic influence?

In this article, we report two cases of pustular psoriasis flaring up after fluoxetine administration. A 21-year-old male patient with localized pustular psoriasis became erythrodermic following commencement of fluoxetine. Even though the lesions were unresponsive to cyclosporine A (Cyc A) treatment, dramatic resolution was observed with discontinuation of fluoxetine. A 44-year-old female patient with pustular psoriasis who was on Cyc A and acitretin therapy was given fluoxetine for her psychiatric symptoms. In the following 5 days, her lesions flared. Owing to previous experience, fluoxetine was stopped. Her lesions improved dramatically in the following 3 days. Exacerbation of psoriasis with antidepressant therapy has been rarely described. An extensive review of the literature revealed four such cases, all of which were seen after the use of selective serotonin reuptake inhibitors (SSRI). A serotoninergic influence in the etiopathogenesis of psoriasis may be possible together with a pharmacogenetic difference in the drug metabolism of these patients. Considering the two patients we presented and the patients previously reported in the literature, aggravation of pustular psoriasis by SSRI should be borne in mind.     

Pustular psoriasis of the nails: treatment and long-term follow-up of 46 patients

BACKGROUND: Pustular psoriasis of the nail apparatus is a common disease that greatly influences the quality of life because of its chronic course and poor response to treatment. OBJECTIVES: To review the clinical and histopathological features, the response to treatment and the long-term follow-up of 46 patients with pustular psoriasis of the nail unit. METHODS: Treatments utilized included oral retinoids (n = 12), oral nimesulide (n = 13), topical calcipotriol (n = 15) and topical steroids (n = 18). Retinoids were utilized as first choice in seven patients with involvement of several digits and in five patients with severe relapses, whereas topical calcipotriol, oral nimesulide or topical steroids were utilized in patients with involvement of a single nail. Topical calcipotriol was also prescribed as maintenance therapy in patients who responded to oral treatment. Twenty-five patients were followed for more than 5 years. RESULTS: Improvement or regression of the lesions was obtained in 23 of 46 patients. Retinoids were effective in six of 12 patients, nimesulide in four of 13, topical calcipotriol in nine of 15 and topical steroids in four of 18. The long-term follow-up showed a complete remission of the disease in only two patients, both affected by pustular psoriasis involving multiple nails. All other patients experienced periodic relapses which were in most cases controlled by regular use of topical calcipotriol. CONCLUSIONS: Severe cases of pustular psoriasis of the nail are best treated with systemic retinoids. Topical calcipotriol is effective in about 50% of patients with localized disorder and is also useful as maintenance therapy after retinoid treatment.     

Improvement of psoriasis by a topical vitamin D3 analogue (MC 903) in a double-blind study

The effect of the non-calciotropic vitamin D3 analogue MC 903 on psoriasis vulgaris was assessed in a double-blind, placebo controlled trial in 30 patients. Lesions on one side of the body were treated for 6 weeks with a cream containing 10 μ/g, 33 μg//g or 100 μg/g MC 903 and lesions on the other side were treated with the cream base alone, according to a randomized design. Nine of the 10 patients in each treatment group completed the study. MC 903 cream gave a statistically significant decrease in erythema, thickness and scaling of the lesions, compared with the control. Overall assessment of psoriasis after 6 weeks showed moderate or excellent improvement in two of nine patients treated with 10 μg/g, in five of nine patients treated with 33 μ/g, and in seven of nine patients treated with 100 μ/g MC 903. Placebo treatment showed a moderate improvement in only one of the 27 patients. The histopathological picture of the psoriatic lesions corresponded with the clinical changes. The patients reported no adverse reactions, and laboratory tests did not show any significant changes; in particular there was no change in serum calcium levels. These results suggest that the vitamin D₃ analogue MC 903 is an effective and safe topical treattnent for psoriasis.     

A clinico - histopathological outcome of 4 weeks methotrexate pluse therapy in psoriasis

A clinico-histopathological study was carried out In 50 patients of psoriasis to see clinical and histological outcome and/or correlation of weekly methotrexate pulse therapy. Clinically, results of therapy were evalutated by estimating the percentage of total body coverage with psoriasis. Prior to therapy, average involvement was 47.5% which after 4 weeks methotrexate therapy reduced to 8. 3%. A complete clearing of psoriasis occurred in 40% of patients after methotrexate therapy. The clinical response started as early as I week in most of patients. Only 2 patients failed to respond even after 4 weeks of therapy. Histopathologically in pretreatmenl biopsy, 34 showed classical psoriatic pathology while in 16 biopsy was suggestive of psoriasis but not confirmative. Histopathological examination after 4 weeks treatment showed that 41 still showed one or more histological evidence of psoriasis, although only two patients had classical, psoriatic pathology, in rest 9 patients there were complete regression. Thus, with methotrexate, clinical clearance was much faster than histopathological clearance.     

The Role of the Nervous System in the Pathophysiology of Psoriasis: A Review of Cases of Psoriasis Remission or Improvement Following Denervation Injury

As most efforts in the last decade have focused on the immunologic basis of inflammatory skin disease, there has been less emphasis on the role of the nervous system in the disease process of psoriasis. Evidence in support of the neurocutaneous pathway has come from observations of patients experiencing unilateral improvement and even complete remission following nerve damage in the affected dermatomal region. The aim of this review was to investigate the role of neuropeptides in the intricate pathophysiology of psoriasis. The PubMed database was searched for individual case reports or case series that reported clearance or significant improvement in psoriatic disease in patients following documented nerve injury. A total of 11 cases were found that reported improvement of psoriatic lesions in areas afflicted by central or peripheral nerve injury. The most common causes of denervation were inadvertent surgical interruption, cerebrovascular accident, and poliomyelitis. In four cases the patients eventually regained neurologic function, which was associated with a recurrence of skin lesions. In cases of permanent nerve damage, there was remission of psoriasis. The cases reported in the literature to date provide clinical evidence that absence of neural input leads to psoriasis improvement, suggesting a crucial role of the nervous system in the pathophysiology of psoriatic disease. In fact, neuropeptides such as nerve growth factor, substance P, calcitonin gene-related peptide, and vasoactive intestinal peptide may be important contributors of psoriatic disease and potential targets for future therapies.     

Successful adalimumab treatment of a psoriasis vulgaris patient with hemodialysis for renal failure: A case report and a review of the previous reports on biologic treatments for psoriasis patients with hemodialysis for renal failure

The efficacy and safety of biologic treatments have been established in patients with moderate to severe psoriasis, but there are few reports on biologic therapy for patients with psoriasis complicated by end‐stage renal failure on hemodialysis (HD). In this report, we demonstrated the efficacy and safety of adalimumab for patients with severe psoriasis on HD. A 46‐year‐old Japanese man with a 14‐year history of psoriasis was referred to our clinic in September 2009. He had developed hypertension and renal failure during a 7‐year history of cyclosporin treatment. With the infliximab treatment, he achieved 75% improvement of the Psoriasis Area and Severity Index (PASI) score within 3 months from the PASI of 42.3 before the treatment. However, his renal failure gradually deteriorated, and HD was initiated at 1 year after the introduction of infliximab. Because of hydration during the i.v. injection of infliximab, he developed pulmonary edema with every infliximab treatment after starting HD. We switched to ustekinumab treatment, but his psoriasis was not improved. Then, we switched to adalimumab and achieved a PASI‐100 response within 2 months. The patient received adalimumab treatment for more than a year without any adverse effects. In addition to our case, five articles reported cases of psoriasis patients with renal failure on HD who were treated with biologics. The psoriatic lesions were improved by biologics in these cases, and no severe adverse effects on the renal function were reported. Thus, biologics are a reasonable treatment option for patients with severe psoriasis with renal failure on HD.     

The value to patients of reducing lesion severity in plaque psoriasis

Plaque psoriasis is associated with significant psychosocial, quality-of-life, and economic burden. The objective of this study was to quantify the value to patients of reducing the severity and size of plaque psoriasis lesions. Subjects included individuals with a self-reported diagnosis of plaque psoriasis from a nationally representative US household panel. Subjects completed a web-based conjoint analysis survey and chose between hypothetical treatments in a series of questions. Each alternative was defined by lesion severity, percentage of body surface area (BSA) covered by lesions, type of treatment, injection discomfort or pain (if treatment included injections), risk of serious lung infection, and monthly out-of-pocket cost. 28,200 panelists were invited to participate. 18,330 responded, 503 qualified, and 419 completed the survey. Mean age was 54.5 years and 52% were female. 64% (35%) of patients reported psoriasis severity as mild or mild to moderate (moderate to very severe). Patients were willing to pay $486.73 out-of-pocket per month to eliminate severe lesions covering 25% BSA on the arms and legs and $444.80 out-of-pocket per month to eliminate moderate lesions covering 4% BSA on the face. Individuals with plaque psoriasis are willing to pay substantial amounts to reduce lesion severity and percentage of BSA covered by lesions.     

Delayed onset of bullous pemphigoid after PUVA and sunlight treatment of psoriasis

The coexistence of bullous pemphigoid and psoriasis has previously been noted. In most patients, the bullous lesions start during PUVA or UVB therapy of psoriasis. We report on a psoriatic patient who developed bullous pemphigoid approximately three to four weeks after discontinuing PUVA treatment, and then three to four weeks after exposure to natural sunlight. Delayed induction of bullous pemphigoid has not been previously reported, and it raises the question of ultraviolet therapy inducing subclinical or latent bullous pemphigoid in psoriatic patients.     

Short-duration dithranol therapy for psoriasis

40 outpatients with psoriasis vulgaris of limited extent were treated with daily brief applications of a 1, 2 or 3% dithranol ointment. The treatment was effective in cases of large plaques, small lesions and guttate psoriasis. There was a very poor therapeutic response in palmoplantar psoriasis and in residual lesions after Ingram's regimen.