Pustular psoriasis induced by infliximab

Pustular psoriasis is an uncommon variant of psoriasis characterized by widespread pustules on an erythematous background. Recent reports document the efficacy of immunobiologic agents such as infliximab in the treatment of pustular psoriasis. We present a patient that developed cutaneous and pathologic changes consistent with pustular psoriasis while receiving treatment with infliximab for chronic ulcerative colitis. More long-term studies need to be conducted in order to fully understand this paradoxical reaction as well as the mechanism of action and side effect profiles of infliximab and other immunobiologic agents.     

Generalized pustular psoriasis following withdrawal of efalizumab

Efalizumab is one of the new biologic therapies targeting T-lymphocyte activity for the treatment of chronic plaque psoriasis. Common adverse effects include headaches, nonspecific infection, nausea, chills, and fever. Rebound of psoriasis following discontinuation of the drug has been reported. Relapse events can manifest as recurrent plaque psoriasis, guttate psoriasis, psoriatic erythroderma, and pustular psoriasis. We report a second case of withdrawal flare resulting in generalized pustular psoriasis.     

Acute pustular psoriasis complicated by leukocytoclastic vasculitis

Acute pustular psoriasis is characterized by fiery-red erythema followed by formation of pustules. Precipitating factors include drugs, infections, pregnancy, solar irradiation, and psychological stress. We present a case of a woman who developed acute onset of pustular psoriasis precipitated by hydroxychloroquine therapy and systemic steroids. The patient's course was complicated by leukocytoclastic vasculitis presumptively caused by levofloxacin.     

Biologics in the treatment of pustular psoriasis

ABSTRACT

Introduction

Pustular psoriasis is a group of skin diseases characterized by neutrophil infiltration in the epidermis and formation of sterile pustules. Conventional treatments, such as retinoids and immunosuppressive drugs, have improved the clinical manifestations; however, many patients suffer from drug-related toxicity or are resistant to therapy.     

Serum sickness due to infliximab in a patient with psoriasis

Infliximab is a chimeric, murine-human, monoclonal antibody against tumor necrosis alpha which has shown great efficacy in the treatment of psoriasis. Serum sickness, which is an immune complex mediated syndrome consisting of a cutaneous eruption, fever, arthritis, edema, and lymphadenopathy, has been described in several patients receiving infliximab for the treatment of Crohn's disease. However, to our knowledge, this type of reaction has not been well described in a patient treated with infliximab for psoriasis. We describe a patient who developed serum sickness while receiving infliximab for psoriasis and discuss the pathogenesis, diagnosis, and treatment of serum sickness. We believe that with the increasing use of infliximab for psoriasis, more cases of serum sickness will occur. Therefore, awareness of this adverse effect is essential.     

Subacute annular generalized pustular psoriasis treated with etanercept and cyclosporine combination

We present a case of a 36-year-old man with a 20-year history of stable plaque psoriasis admitted to our inpatient dermatology unit with subacute annular pustular psoriasis. Two weeks prior to admission the patient's dermatologist discontinued the use of 5 lbs (2.3 kg) of triamcinolone 0.1% cream, which the patient had been applying to his skin weekly over the last 8 years. The patient subsequently developed generalized erythematous annular and irregularly shaped, well-defined plaques and confluent pustules. Approximately 80% of his total body surface area was involved, sparing the face and the genitals. Initial therapy included cyclosporine 300 mg twice daily, topical hydrocortisone 1% ointment to affected areas, acetaminophen/oxycodone 10/325 mg every 4 hours for pain as needed, and subcutaneous etanercept 50 mg twice weekly. The patient was discharged on day 7 with significant improvement of skin lesions. On discharge the cyclosporine was increased to 400 mg twice daily. The patient continued etanercept 50 mg twice weekly. One month after discharge the patient was clear with only postinflammatory changes.     

Osteomyelitis occurring during infliximab treatment of severe psoriasis

Tumor necrosis factor alpha (TNF-alpha) inhibitors, such as infliximab, decrease the body's inflammatory response and thus the body's reaction to infection. Given the immune-mediated processes in psoriasis and psoriatic arthritis, patients with these disorders may benefit from infliximab therapy but may also suffer from an increased risk of infection. We present the first case of osteomyelitis in a patient receiving infliximab therapy for severe psoriasis and psoriatic arthritis. Infliximab and its serious adverse effects are discussed, and other cases of osteomyelitis with infliximab use are also reviewed.     

环孢素A与阿维A治疗泛发性脓疱型银屑病的疗效观察

目的探讨环孢素A与阿维A治疗泛发性脓疱型银屑病（GPP）的临床疗效。方法将60例GPP随机均分为A组和B组．A组采用环孢素A治疗、B组采用阿维A治疗。比较两组的临床疗效、症状和体征消失时间、复发率及不良反应。结果A组总有效率和复发率分别为80．0％、10．0％,B组为86．7％、1313％,两组比较差异均无统计学意义（P〉0．05）。A组体温恢复正常时间及红斑、脓疱消退时间短于B组。血压升高发生率高于B组,肝功能损害和血脂异常发生率低于B组,差异均有统计学意义（P〈0．01和P〈0．05）。结论环孢素A与阿维A治疗GPP效果相似。当阿维A治疗GPP无效,可选用环孢素A作为替代药物治疗。     

环孢素A与甲氨蝶呤治疗难治性泛发性脓疱型银屑病疗效比较

目的探讨环孢素A与甲氨蝶呤(MTX)治疗难治性泛发性脓疱型银屑病(GPP)的临床疗效。方法将48例难治性GPP随机分为A组和B组各24例。A组采用环孢素A治疗,B组采用MTX治疗。比较2组的临床疗效、症状和体征消失时间、复发率及不良反应。结果 A组总有效率和复发率分别为87.5%、8.3%,B组为79.2%、12.5%,2组比较差异均无统计学意义(P>0.05)。A组体温恢复正常时间及红斑、脓疱消退时间短于B组;血压升高发生率高于B组,肝功能、血常规异常发生率低于B组,差异均有统计学意义(P<0.05和P<0.01)。但2组肾功能、尿常规异常发生率比较差异无统计学意义(P>0.05)。结论环孢素A与MTX治疗难治性GPP均能取得较好的临床疗效,且环孢素A具有起效更快、对肝功能影响较小等优点。     

阿维A联合甲氨蝶呤治疗难治性泛发性脓疱型银屑病的疗效观察

目的：探讨阿维A联合甲氨蝶呤治疗难治性泛发性脓疱型银屑病的疗效及安全性。方法169例难治性泛发性脓疱型银屑病患者,采用数字表法随机分为阿维A组、甲氨蝶呤组以及阿维A与甲氨蝶呤联合治疗组,观察不同治疗方法的临床疗效与安全性。结果联合治疗组的总有效率为96．55％,明显高于阿维A组的83．93％以及甲氨蝶呤组的80．00％（χ2＝5．210、7．603,均P＜0．05）。联合治疗组不良反应发生率为41．38％,显著高于阿维A组的21．43％（χ2＝5．251,P＜0．05）。结论阿维A联合甲氨蝶呤治疗难治性泛发性脓疱型银屑病的临床疗效显著,安全性好,值得在临床中推广应用。     

Induction of lesional and circulating leukocyte apoptosis by infliximab in a patient with moderate to severe psoriasis

Infliximab demonstrates high efficacy in treating psoriasis in a high proportion of patients. In this report we demonstrate induction of plaque (T cells, dendritic cells) and peripheral blood (T cells, monocytes) leukocyte apoptosis following a single infliximab infusion in a psoriasis patient.     

降钙素原及白细胞介素-6在泛发性脓疱型银屑病53例中的表达及意义

目的 通过检测降钙素原及白细胞介素（IL）-6在泛发性脓疱型银屑病（GPP）病人血清中的表达水平,为病情和疗效评估寻找标志物。方法 收集安徽医科大学第一附属医院2017年1月至2019年12月收治的132例住院银屑病病人的病历资料,入组病人包括寻常型银屑病（PV）46例,红皮病型银屑病（EP）33例,以及GPP 53例,并针对各组病人的年龄、性别和发病年龄等人口学特征以及外周血中降钙素原及IL-6含量进行统计分析。结果 治疗前GPP病人的降钙素原、IL-6含量分别为（0.41±0.14）μg/L、（57.75±11.48）ng/L,显著高于PV组的（0.11±0.05）μg/L、（21.76±8.28）ng/L及EP组的（0.14±0.04）μg/L、（32.57±9.39）ng/L(P<0.05)。治疗后GPP病人降钙素原、IL-6水平均明显降低至（0.03±0.01）μg/L、（4.22±1.13）ng/L,较治疗前差异有统计学意义（P<0.05）。ROC分析显示：降钙素原、IL-6及其联合应用对GPP病人病情严重程度的评估有较高价值,其AUC 95%CI分别为0.73...     

阿维A与其他药物治疗脓疱型银屑病疗效对比分析

目的 评价阿维A、甲氨蝶呤、复方甘草酸苷注射液治疗脓疱型银屑病的疗效差异.方法 将156例患者随机分成3组,A组75例患者口服阿维A胶囊 10 mg,每日3次;B组45例患者口服甲氨蝶呤2.5 mg,每日1次;C组36例患者用复方甘草酸苷注射液20ml加入5％葡萄糖溶液250 ml静脉滴注,每日1次.3组疗程均为8周.结果 A、B、C3组有效率分别为88.00％、75.56％、66.67％.3种药物治疗脓疱型银屑病的有效率比较,差异有统计学意义(P＜0.01);不良反应发生率分别为37.33％、64.44％和8.33％,3种药物不良反应发生率比较,差异有统计学意义(P＜0.01);追踪随访治愈患者3个月,A、B、C3组复发率分别为7.69％、47.62％和10.00％,3种药物治疗脓疱型银屑病的复发率比较差异有统计学意义(P＜0.01).结论 阿维A能更有效地控制脓疱型银屑病的症状,疗效明显,复发率低,值得在临床推广使用.     

复方甘草酸苷联合阿维A治疗泛发性脓疱型银屑病的临床分析

目的观察复方甘草酸苷联合阿维A治疗泛发性脓疱型银屑病（GPP）的临床效果。方法将本院2011年8月～2012年8月收治的72例GPP患者随机分为两组,其中对照组单纯给予阿维A治疗,观察组采取复方甘草酸苷联合阿维A治疗,比较两组临床治疗效果及不良反应发生情况。结果观察组总有效率为91．67％,明显高于对照组（P〈0．05）;观察组热退时间、皮损消失时间和住院时间均明显短于对照组（P〈0．05）;两组不良反应发生率差异无统计学意义（P〉0．05）。结论复方甘草酸苷联合阿维A治疗GPP疗效显著,可明显改善患者临床症状,且不良反应少,值得临床推广和应用。     

脓疱型银屑病患者静脉滴注复方甘草酸苷致严重过敏反应二例

复方甘草酸苷具有抗炎、抗过敏及调节免疫作用,皮肤科常选用于治疗湿疹、药疹等变态反应性疾病的治疗。本文报道2例脓疱型银屑病患者静脉滴注复方甘草酸苷后导致严重过敏反应案例,希望能够提醒临床用药时密切监护该药物的此类不良反应。     

英夫利西单抗治疗寻常性银屑病的疗效及对血脂代谢的影响

目的 回顾性分析英夫利西单抗治疗寻常性银屑病的疗效及对血脂代谢的影响.方法 纳入2015年1月至2020年12月在上海市皮肤病医院住院期间采用英夫利西单抗治疗的寻常型银屑病患者,比较治疗前后血脂代谢水平[包括甘油三酯(TG)、胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、载脂蛋白A1和载脂蛋白...     

Biological therapy for psoriasis: an overview of infliximab, etanercept, efalizumab and alefacept

Psoriasis is a chronic skin disorder that affects approximately 2% of the US and European population. Over the last several years one of the major foci in psoriasis research has been the development of biological therapies for this disease. The aim of these therapies is to provide selective, immunologically directed intervention with fewer side effects than traditional therapies. This article will review the progress of four biological agents that are available or under investigation for clinical use: infliximab (Centocor Inc), etanercept (Amgen Inc/Wyeth), efalizumab (Genentech Inc/XOMA Ltd/Serono SA) and alefacept.