1
|
Montero-Menárguez J, Amat Samaranch V, Puig Sanz L, Ruiz-Villaverde R, Arias-Santiago S, Larrea García M, Ruiz Genao D, Ferrán M, Schneller-Pavelescu L, Romero Ferreiro C, Rivera Díaz R. Pityriasis Rubra Pilaris: A Multicentric Case Series of 65 Spanish Patients. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00526-X. [PMID: 38964605 DOI: 10.1016/j.ad.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/13/2023] [Accepted: 02/06/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION PRP is a rare entity of unknown etiopathogenesis. Lack of management guidelines makes it a challenge for clinicians. OBJECTIVE To add our experience to increase evidence about PRP. METHODS We performed a retrospective, descriptive and multicentric study of 65 patients with PRP, being the largest European case series of patients with PRP. RESULTS PRP was more frequent in male patients with an average age of 51 years, but erythrodermic forms presented in older patients (average age 61 years). Six (75%) paediatric patients and ten (60%) non-erythrodermic adults controlled their disease with topical corticosteroids. On the contrary, 26 (68%) erythrodermic patients required biologic therapy as last and effective therapy line requiring an average of 6.5 months to achieve complete response. CONCLUSION Our study showed a statistical difference in terms of outcome and response to treatment between children or patients with limited disease and patients who develop erythroderma.
Collapse
Affiliation(s)
- J Montero-Menárguez
- Dermatology Department of the Hospital Universitario 12 de Octubre, Madrid, España.
| | - V Amat Samaranch
- Dermatology Department of Hospital de la Santa Creu i Sant Pau de Barcelona, España
| | - L Puig Sanz
- Dermatology Department of Hospital de la Santa Creu i Sant Pau de Barcelona, España
| | - R Ruiz-Villaverde
- Dermatology Department of Hospital Universitario San Cecilio de Granada, España
| | - S Arias-Santiago
- Dermatology Department of Hospital Virgen de las Nieves de Granada, School of Medicine, Granada University, Instituto de Investigación Biosanitaria IBS, Granada, España
| | - M Larrea García
- Dermatology Department of Hospital Universitario de Navarra, España
| | - D Ruiz Genao
- Dermatology Department of Fundación Hospital Alcorcón, España
| | - M Ferrán
- Dermatology Department of Hospital del Mar de Barcelona, España
| | | | - C Romero Ferreiro
- Unidad de Soporte Científico, Instituto de Investigación Sanitaria, Hospital Universitario 12 de Octubre, España; Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España
| | - R Rivera Díaz
- Dermatology Department of the Hospital Universitario 12 de Octubre, Madrid, España
| |
Collapse
|
2
|
Holmes Z, Goh MS, Foley P, Daniel BS. Tildrakizumab use for recalcitrant pityriasis rubra pilaris. Australas J Dermatol 2024. [PMID: 38814107 DOI: 10.1111/ajd.14307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/04/2024] [Accepted: 05/03/2024] [Indexed: 05/31/2024]
Affiliation(s)
- Zachary Holmes
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Michelle S Goh
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Peter Foley
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Skin Health Institute, Carlton, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Benjamin S Daniel
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Chandy RJ, Chokshi A, Tan I, Feldman SR. Biologics for Treatment of Pityriasis Rubra Pilaris: A Literature Review. J Cutan Med Surg 2024; 28:269-275. [PMID: 38549359 DOI: 10.1177/12034754241238735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To describe the published efficacy and adverse event rates associated with existing biologics for the treatment of pityriasis rubra pilaris (PRP). DATA SOURCES A literature review using the PubMed database (January 1990-July 2023) was conducted. Multiple search combinations were conducted using "pityriasis rubra pilaris" and various biologics as keywords to identify relevant articles. STUDY SELECTION AND DATA EXTRACTION Inclusion criteria included all study types that were published within the past 30 years in English and mentioned at least one biologic and PRP. A preliminary search yielded a total of 499 results. After screening using inclusion and exclusion criteria, 77 relevant articles (69 case reports, 5 case series, 2 clinical trials, and 1 retrospective analysis) were analyzed. DATA SYNTHESIS TNF-α inhibitors have been evaluated and are effective in treating PRP. However, recent treatment with anti-interleukin (IL)-17 and anti-IL-23 therapies such as ustekinumab, secukinumab, and ixekizumab are emerging as new treatment options with a mean improvement in PRP Area and Severity Index scores, change in severity of erythema, scaling, and thickness of PRP lesions. From initial clinical trials, secukinumab and ixekizumab are promising treatment options for achieving remission. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review compares the efficacy for numerous biologics and a discussion to guide clinicians on benefits and risks in choosing a biologic for PRP patients. CONCLUSIONS Biologics may be a favourable treatment option leading to greater patient adherence due to reduced dosing frequencies, improvement in quality of life, and reduction in frequency and severity of flares.
Collapse
Affiliation(s)
- Rithi J Chandy
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Aditi Chokshi
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Isabella Tan
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
4
|
Joshi TP, Duvic M. Pityriasis Rubra Pilaris: An Updated Review of Clinical Presentation, Etiopathogenesis, and Treatment Options. Am J Clin Dermatol 2024; 25:243-259. [PMID: 38159213 DOI: 10.1007/s40257-023-00836-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
Pityriasis rubra pilaris (PRP) is a rare papulosquamous reaction pattern with a significant impact on quality of life. Type I PRP is the most common PRP variant, presenting as erythematous papules emerging in a follicular distribution and later coalescing into plaques with characteristic islands of sparing; histologically, an alternating pattern of orthokeratosis and parakeratosis is considered the hallmark of PRP (checkerboard hyperkeratosis). Other PRP variants (types II-V) differ in their age of onset and clinical presentation. Type VI PRP is a rare PRP subtype associated with human immunodeficiency virus infection and is occasionally associated with diseases of the follicular occlusion tetrad. Caspase recruitment domain family, member 14 (CARD14)-associated papulosquamous eruption and facial discoid dermatitis are newly described disease states that have an important clinical overlap with PRP, creating shared conundrums with respect to diagnosis and treatment. The etiology inciting PRP often remains uncertain; PRP has been suggested to be associated with infection, malignancy, or drug/vaccine administration in some cases, although these are based on case reports and causality has not been established. Type V PRP is often due to inborn CARD14 mutations. Furthermore, recent literature has identified interleukin-23/T-helper-17 cell axis dysregulation to be a major mediator of PRP pathogenesis, paving the way for mechanism-directed therapy. At present, high-dose isotretinoin, ixekizumab, and secukinumab are systemic agents supported by single-arm prospective studies; numerous other agents have also been trialed for PRP, with variable success rates. Here, we discuss updates on clinical manifestations, present new insights into etiopathogenesis, and offer a survey of recently described therapeutic options.
Collapse
Affiliation(s)
- Tejas P Joshi
- School of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Madeleine Duvic
- Department of Dermatology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
5
|
Montero-Menárguez J, Amat Samaranch V, Puig Sanz L, Ruiz-Villaverde R, Arias-Santiago S, Larrea García M, Ruiz Genao D, Ferrán M, Schneller-Pavelescu L, Romero Ferreiro C, Rivera Díaz R. Pityriasis Rubra Pilaris: A Multicentric Case Series of 65 Spanish Patients. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00161-3. [PMID: 38401879 DOI: 10.1016/j.ad.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/13/2023] [Accepted: 02/06/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION PRP is a rare entity of unknown etiopathogenesis. Lack of management guidelines makes it a challenge for clinicians. OBJECTIVE To add our experience to increase evidence about PRP. METHODS We performed a retrospective, descriptive and multicentric study of 65 patients with PRP, being the largest European case series of patients with PRP. RESULTS PRP was more frequent in male patients with an average age of 51 years, but erythrodermic forms presented in older patients (average age 61 years). Six (75%) paediatric patients and ten (60%) non-erythrodermic adults controlled their disease with topical corticosteroids. On the contrary, 26 (68%) erythrodermic patients required biologic therapy as last and effective therapy line requiring an average of 6.5 months to achieve complete response. CONCLUSION Our study showed a statistical difference in terms of outcome and response to treatment between children or patients with limited disease and patients who develop erythroderma.
Collapse
Affiliation(s)
- J Montero-Menárguez
- Dermatology Department of the Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - V Amat Samaranch
- Dermatology Department of Hospital de la Santa Creu i Sant Pau de Barcelona, Spain
| | - L Puig Sanz
- Dermatology Department of Hospital de la Santa Creu i Sant Pau de Barcelona, Spain
| | - R Ruiz-Villaverde
- Dermatology Department of Hospital Universitario San Cecilio de Granada, Spain
| | - S Arias-Santiago
- Dermatology Department of Hospital Virgen de las Nieves de Granada, School of Medicine, Granada University, Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - M Larrea García
- Dermatology Department of Hospital Universitario de Navarra, Spain
| | - D Ruiz Genao
- Dermatology Department of Fundación Hospital Alcorcón, Spain
| | - M Ferrán
- Dermatology Department of Hospital del Mar de Barcelona, Spain
| | | | - C Romero Ferreiro
- Unidad de Soporte Científico, Instituto de Investigación Sanitaria, Hospital Universitario 12 de Octubre, Spain; Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - R Rivera Díaz
- Dermatology Department of the Hospital Universitario 12 de Octubre, Madrid, Spain
| |
Collapse
|
6
|
Villa-Gonzalez JM, Gonzalez-Hermosa MR, Atxutegi-Ayesta X, Ratón Nieto JA, Gardeazabal García J, Lasa Elgezua O. Rapid response of erythrodermic pityriasis rubra pilaris to tildrakizumab. Clin Exp Dermatol 2024; 49:177-180. [PMID: 37847660 DOI: 10.1093/ced/llad352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 09/21/2023] [Indexed: 10/19/2023]
Abstract
The cases of two patients with erythrodermic pityriasis rubra pilaris that showed a rapid and virtually complete response to tildrakizumab are presented. Treatment of pityriasis rubra pilaris remains challenging and there is very little evidence about use of interleukin-23 blockers in this condition. These cases may contribute to extending the available therapeutic options, especially when a fast clearance of the lesions is needed.
Collapse
Affiliation(s)
| | | | | | | | | | - Olatz Lasa Elgezua
- Department of Dermatology at Cruces University Hospital, Barakaldo, Biscay, Spain
| |
Collapse
|
7
|
Kromer C, Schön MP, Mössner R. Bimekizumab in refractory pityriasis rubra pilaris. J Dtsch Dermatol Ges 2024; 22:102-104. [PMID: 38066410 DOI: 10.1111/ddg.15252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/10/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Christian Kromer
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany
| | - Michael P Schön
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany
- Lower Saxony Institute of Occupational Dermatology, University Medical Center, Göttingen, Germany
| | - Rotraut Mössner
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany
| |
Collapse
|
8
|
Smyk J, Kamińska A, Borowy P, Major P, Gołojuch K, Batko B. Pityriasis Rubra Pilaris - a difficult path to optimal treatment. Case report. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2024; 52:363-367. [PMID: 39007476 DOI: 10.36740/merkur202403114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Pityriasis Rubra Pilaris is a rare, chronic inflammatory dermatosis of unknown etiology, presenting with erythema and papular eruptions. Treatment is difficult due to the lack of causal therapy, guidelines and requires an individualized approach. The most common treatments are systemic retinoids, immunosuppressants, phototherapy and biological therapy. This article presents the case of a 73-year-old man suffering from type 1 pityriasis rubra pilaris. The patient was initially treated with acitretin, which was discontinued due to hypogammaglobulinemia. This rare side effect of acitretin has not been previously published. As a second-line treatment, the patient received methotrexate, but with no clinical improvement after 3 months and an increase in skin pruritus. Finally, the use of isotretinoin resulted in significant clinical improvement and was well tolerated.
Collapse
Affiliation(s)
- Jakub Smyk
- DEPARTMENT OF RHEUMATOLOGY AND IMMUNOLOGY, ANDRZEJ FRYCZ-MODRZEWSKI CRAKOW UNIVERSITY, CRAKOW, POLAND
| | - Alicja Kamińska
- DEPARTMENT OF RHEUMATOLOGY AND IMMUNOLOGY, ANDRZEJ FRYCZ-MODRZEWSKI CRAKOW UNIVERSITY, CRAKOW, POLAND
| | - Przemysław Borowy
- DEPARTMENT OF RHEUMATOLOGY AND IMMUNOLOGY, J. DIETL HOSPITAL, CRACOW, POLAND
| | - Patrycja Major
- DEPARTMENT OF RHEUMATOLOGY AND IMMUNOLOGY, ANDRZEJ FRYCZ-MODRZEWSKI CRAKOW UNIVERSITY, CRAKOW, POLAND
| | - Katarzyna Gołojuch
- DEPARTMENT OF RHEUMATOLOGY AND IMMUNOLOGY, ANDRZEJ FRYCZ-MODRZEWSKI CRAKOW UNIVERSITY, CRAKOW, POLAND
| | - Bogdan Batko
- DEPARTMENT OF RHEUMATOLOGY AND IMMUNOLOGY, J. DIETL HOSPITAL, CRACOW, POLAND
| |
Collapse
|
9
|
Kromer C, Schön MP, Mössner R. Bimekizumab bei refraktärer Pityriasis rubra pilaris: Bimekizumab in refractory pityriasis rubra pilaris. J Dtsch Dermatol Ges 2024; 22:102-105. [PMID: 38212908 DOI: 10.1111/ddg.15252_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/10/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Christian Kromer
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| | - Michael P Schön
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
- Niedersächsisches Institut für Berufsdermatologie, Universitätsklinikum Göttingen
| | - Rotraut Mössner
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| |
Collapse
|
10
|
Kołt-Kamińska M, Osińska A, Kaznowska E, Reich A. Successful Treatment of Pityriasis Rubra Pilaris with Risankizumab in Children. Dermatol Ther (Heidelb) 2023; 13:2431-2441. [PMID: 37704911 PMCID: PMC10539248 DOI: 10.1007/s13555-023-01005-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/03/2023] [Indexed: 09/15/2023] Open
Abstract
Pityriasis rubra pilaris (PRP) is a rare inflammatory skin disease that affects men and women of all ages, including children. PRP is characterized by follicular and palmoplantar hyperkeratosis and salmon-colored scaling plaques. The exact pathogenesis of PRP is still unknown; most PRP cases are acquired, but some cases may show a familial occurrence, often associated with a mutation in the CARD14 gene. Due to the rarity of PRP, treatment recommendations are based mainly on case reports, small case series and expert opinions and still represent a major therapeutic challenge, especially in children. A growing number of reports on treatment with biologicals, particularly anti-TNFα, has been published. However, an involvement of the IL-23/Th17 axis in both psoriasis and PRP pathogenesis may suggest that this pathway may be a potential therapeutic target. Here, we present three pediatric patients with PRP successfully treated with risankizumab. All patients exhibited a severe course of PRP and lack of response to conventional therapy, including acitretin, cyclosporine and phototherapy. A single dose of 75 mg risankizumab resulted in almost complete clearance of skin lesions in case 1 and 2 at week 4. In patient 3, clear skin was achieved after the second administration of risankizumab (150 mg). All patients continue the treatment with risankizumab, and no adverse effects have been reported up to the present time. Our study demonstrates that risankizumab, an IL-23 blocker, shows good efficacy and safety among pediatric patients with PRP.
Collapse
Affiliation(s)
- Marta Kołt-Kamińska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Szopena 2, 35-055, Rzeszów, Poland
| | | | - Ewa Kaznowska
- Department of Pathomorphology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszów, Poland
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Szopena 2, 35-055, Rzeszów, Poland.
| |
Collapse
|
11
|
Ying Y, Yu-Hua L, Xiao-Yan W, Su-Chun H. A case of pityriasis rubra pilaris treated with tofacitinib after failure with acitretin and ixekizumab. Australas J Dermatol 2023; 64:445-447. [PMID: 37200390 DOI: 10.1111/ajd.14076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/12/2023] [Accepted: 04/28/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Yang Ying
- Department of Dermatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Liu Yu-Hua
- Department of Dermatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Wu Xiao-Yan
- Department of Dermatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Hou Su-Chun
- Department of Dermatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| |
Collapse
|
12
|
Guenther J, Novack D, Kamath S, Worswick S. Treatment Options for Juvenile Pityriasis Rubra Pilaris. Paediatr Drugs 2023; 25:151-164. [PMID: 36529810 DOI: 10.1007/s40272-022-00549-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
Pityriasis rubra pilaris represents a group of familial and acquired disorders of cornification that affect both adult and pediatric patients. Treatment options are difficult to assess through clinical trials, given the rarity of the disorder and its tendency for spontaneous remission. Case reports and case series are therefore the primary means of assessment. Because of the heterogeneity of the disease, there is no universal approach to treatment, and multiple agents may need to be trialed to achieve disease control. At present, topicals are used for most pediatric patients, though monotherapy with topicals is only effective for less severe disease. Despite concerns over their side-effect profiles, oral retinoids are generally accepted as a first-line systemic therapy. However, interleukin-17 inhibitors and ustekinumab, an interleukin-12 and interleukin-23 inhibitor, may soon become first-line systemic treatment as well, given their efficacy and relative safety in trials thus far. Ustekinumab, in particular, is emerging as a first-line agent for patients with pityriasis rubra pilaris with CARD14 gene variations. When these therapies fail, second-line and adjunctive therapies to consider include tumor necrosis factor-alpha inhibitors, methotrexate, and phototherapy. However, further investigation is necessary to assess the safety and efficacy of many of these agents in juvenile pityriasis rubra pilaris.
Collapse
Affiliation(s)
- Jana Guenther
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Sonia Kamath
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Scott Worswick
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| |
Collapse
|
13
|
Zhang LW, Wang WJ, Fu LX, Lu YH, Chen T, Xu RH. Pityriasis rubra pilaris following inactivated SARS-CoV-2 vaccine (CoronaVac). J Eur Acad Dermatol Venereol 2023; 37:e287-e288. [PMID: 36504416 DOI: 10.1111/jdv.18768] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/09/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Li-Wen Zhang
- Department of Dermatovenereology, Chengdu Second People's Hospital, Chengdu, China
| | - Wen-Ju Wang
- Department of Dermatovenereology, Chengdu Second People's Hospital, Chengdu, China
| | - Li-Xin Fu
- Department of Dermatovenereology, Chengdu Second People's Hospital, Chengdu, China
| | - Yong-Hong Lu
- Department of Dermatovenereology, Chengdu Second People's Hospital, Chengdu, China
| | - Tao Chen
- Department of Dermatovenereology, Chengdu Second People's Hospital, Chengdu, China
| | - Rong-Hua Xu
- Institute of Dermatology, Chengdu Second People's Hospital, Chengdu, China
| |
Collapse
|
14
|
Fouarge AL, Cuvelier M, Roquet-Gravy C, de Montjoye L, Baeck M. Successful treatment of pityriasis rubra pilaris with risankizumab, a IL-23/p19 antagonist. J Eur Acad Dermatol Venereol 2023; 37:e106-e109. [PMID: 35972816 DOI: 10.1111/jdv.18516] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/05/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Anne-Laure Fouarge
- Division of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Marie Cuvelier
- Division of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Charlotte Roquet-Gravy
- Division of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Laurence de Montjoye
- Division of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Marie Baeck
- Division of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| |
Collapse
|
15
|
Saad M, Spurr A, Lipson J. Pityriasis rubra pilaris partially responsive to treatment with upadacitinib: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231160927. [PMID: 37009550 PMCID: PMC10064474 DOI: 10.1177/2050313x231160927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Pityriasis rubra pilaris is a rare inflammatory dermatosis characterized by orange-red confluent plaques, hyperkeratotic follicular papules, palmoplantar keratoderma, and, in some cases, erythroderma. The etiology of pityriasis rubra pilaris is unclear. This condition is often treated with oral retinoids and topical corticosteroids, and more recently, biological agents have become the mainstay of treatment. However, there is a paucity of high-quality evidence on the safety and effectiveness of these agents, and the disease often remains refractory to therapy. Herein, we present a case of pityriasis rubra pilaris with a favorable response to treatment with upadacitinib, a Janus kinase inhibitor, which has not been previously reported in the literature for the management of this condition.
Collapse
Affiliation(s)
- Mysa Saad
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alison Spurr
- Division of Dermatology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Lipson
- Division of Dermatology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Jennifer Lipson, Division of Dermatology, The Ottawa Hospital, University of Ottawa, 737 Parkdale Avenue, Ottawa, ON K1Y 4M9, Canada.
| |
Collapse
|
16
|
Pham JP, Allen N, Smith A. Efficacy of ustekinumab and guselkumab in treatment refractory pityriasis rubra pilaris: A case series. Australas J Dermatol 2022; 63:522-524. [PMID: 36129444 DOI: 10.1111/ajd.13925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/13/2022] [Accepted: 09/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- James P Pham
- St. Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia.,School of Clinical Medicine, St Vincent's Clinical School, UNSW Medicine and Health, Sydney, New South Wales, Australia
| | - Nicholas Allen
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Annika Smith
- St. Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Dermatology, Westmead Hospital, Westmead, New South Wales, Australia
| |
Collapse
|
17
|
Rypka KJ, Fulk TS, Afsaneh A, Miller DD, Goldfarb NI. Improvement of Facial Discoid Dermatosis With Ustekinumab Treatment. JAMA Dermatol 2022; 158:1079-1080. [PMID: 35767241 DOI: 10.1001/jamadermatol.2022.2478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Travis S Fulk
- Department of Dermatology, University of Minnesota, Minneapolis.,Department of Dermatology, Minneapolis VA Medical Center, Minneapolis
| | - Alavi Afsaneh
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Daniel D Miller
- University of Minnesota Medical School, Minneapolis.,Department of Dermatology, University of Minnesota, Minneapolis
| | - Noah I Goldfarb
- University of Minnesota Medical School, Minneapolis.,Department of Dermatology, University of Minnesota, Minneapolis.,Department of Dermatology, Minneapolis VA Medical Center, Minneapolis.,Department of Internal Medicine, Minneapolis VA Medical Center, Minneapolis
| |
Collapse
|
18
|
Joshi TP, Wang HY, Athukuri P, Bohac S, Farr MA, Hinson D, Kahla JA, Khalfe N, McBee DB, Stroh R, Walters N, Ren V. Biologic Therapies for the Management of Cutaneous Findings in Genodermatoses: A Review. Am J Clin Dermatol 2022; 23:673-688. [PMID: 35606649 DOI: 10.1007/s40257-022-00700-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 01/17/2023]
Abstract
Genodermatoses are genetically inherited dermatologic conditions. The management of cutaneous findings in genodermatoses is challenging, and first-line therapies, such as steroids and/or retinoids, are often inadequate. In recent years, research on the molecular basis of genodermatoses has led to the use of biologic therapies for intractable disease. Here, we review the evidence regarding the use of available biologic therapies for the management of dermatologic findings in genodermatoses. Biologic therapies appear to be promising therapeutic options for several recalcitrant genodermatoses, especially those with underlying immune dysregulation. However, not all genodermatoses are amenable to biologic therapies, and some have been shown to paradoxically worsen under treatment. Biologic therapies offer a novel avenue to target refractory genodermatoses. However, evidence supporting the use of biologic therapies in the management of genodermatoses is mostly limited to case reports and case series. Further studies are warranted to determine the safety and efficacy of biologic therapies for the management of cutaneous findings in genodermatoses.
Collapse
|
19
|
DeBiasio C, Cyr J, Ayroud Y, Glassman SJ. A case of classic adult pityriasis rubra pilaris successfully treated with a combination of acitretin and ustekinumab: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221093453. [PMID: 35465019 PMCID: PMC9021576 DOI: 10.1177/2050313x221093453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Classic adult pityriasis rubra pilaris is a severe papulosquamous disease that tends to resolve in 3-5 years but can have a devastating impact on patients while active. It shares features with psoriasis, but treatment remains largely empiric, based on case reports and series. The condition is often refractory to treatment, especially initially, with topical corticosteroids and oral acitretin the more commonly employed agents. Relatively high doses of acitretin are needed for adequate response, and adverse events often limit adherence. Given the similarity to psoriasis, biologic agents approved for psoriasis have been used with good effect in classic adult pityriasis rubra pilaris and show better tolerance than other agents. In this report, we describe the successful use of a combination of acitretin and ustekinumab in a case of classic adult pityriasis rubra pilaris.
Collapse
Affiliation(s)
- Celina DeBiasio
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Janelle Cyr
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Yasmine Ayroud
- Department of Anatomical Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Steven J Glassman
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
20
|
Zagarella SS, Jiang KW. Successful treatment of pityriasis rubra pilaris with tildrakizumab. Australas J Dermatol 2021; 63:120-121. [PMID: 34854479 DOI: 10.1111/ajd.13753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Samuel S Zagarella
- Department of Dermatology, Concord Repatriation General Hospital, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Kevin W Jiang
- Department of Dermatology, Concord Repatriation General Hospital, Sydney, Australia
| |
Collapse
|
21
|
Pham JP, Star P, Wong S, Damian DL, Saw RPM, Whitfeld MJ, Menzies AM, Joshua AM, Smith A. Cutaneous sarcoidosis due to immune‐checkpoint inhibition and exacerbated by a novel BRAF dimerization inhibitor. SKIN HEALTH AND DISEASE 2021; 1:e71. [PMID: 35663773 PMCID: PMC9060087 DOI: 10.1002/ski2.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 11/25/2022]
Abstract
Sarcoidosis is a non‐infective granulomatous disorder of unknown aetiology, with cutaneous involvement affecting up to 30% of patients. Drug‐induced sarcoidosis has been reported secondary to modern melanoma therapies including immune‐checkpoint inhibitors and first generation BRAF inhibitors such as vemurafenib and dabrafenib. Herein, we report a case of cutaneous micropapular sarcoidosis that first developed on immune‐checkpoint inhibition with ipilimumab and nivolumab for metastatic melanoma, which was exacerbated and further complicated by pityriasis rubra pilaris‐like palmar plaques upon transition to a next‐generation BRAF‐dimerisation inhibitor. Both the micropapular eruption and palmar plaques rapidly resolved after cessation of the novel BRAF‐inhibitor and concurrent commencement of hydroxychloroquine. It is unclear how inhibition of BRAF‐dimerisation results in granuloma formation, though upregulation of TH1/TH17 T‐cells and impairment of T‐reg cells may be responsible. Clinicians should be aware of the potential for exacerbation of sarcoidosis when transitioning from immune‐checkpoint inhibitors to these novel BRAF‐dimerisation inhibitors, particularly as their uptake in treating cancers increases beyond clinical trials. Further studies are required to assess whether these next‐generation agents can trigger sarcoidosis de‐novo, or simply exacerbate pre‐existing sarcoidosis.
Collapse
Affiliation(s)
- J. P. Pham
- St Vincent's Hospital Sydney New South Wales Australia
- St Vincent's Clinical School University of New South Wales Darlinghurst New South Wales Australia
| | - P. Star
- St Vincent's Hospital Sydney New South Wales Australia
| | - S. Wong
- St Vincent's Hospital Sydney New South Wales Australia
| | - D. L. Damian
- Melanoma Institute of Australia The University of Sydney Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Royal Prince Alfred Hospital Camperdown New South Wales Australia
| | - R. P. M. Saw
- Melanoma Institute of Australia The University of Sydney Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Royal Prince Alfred Hospital Camperdown New South Wales Australia
| | - M. J. Whitfeld
- St Vincent's Hospital Sydney New South Wales Australia
- St Vincent's Clinical School University of New South Wales Darlinghurst New South Wales Australia
- The Skin Hospital Darlinghurst New South Wales Australia
| | - A. M. Menzies
- Melanoma Institute of Australia The University of Sydney Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Royal North Shore and Mater Hospitals Sydney New South Wales Australia
| | - A. M. Joshua
- St Vincent's Hospital Sydney New South Wales Australia
- St Vincent's Clinical School University of New South Wales Darlinghurst New South Wales Australia
| | - A. Smith
- St Vincent's Hospital Sydney New South Wales Australia
- Melanoma Institute of Australia The University of Sydney Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- The Skin Hospital Darlinghurst New South Wales Australia
| |
Collapse
|
22
|
Shao S, Chen J, Swindell WR, Tsoi LC, Xing X, Ma F, Uppala R, Sarkar MK, Plazyo O, Billi AC, Wasikowski R, Smith KM, Honore P, Scott VE, Maverakis E, Kahlenberg JM, Wang G, Ward NL, Harms PW, Gudjonsson JE. Phospholipase A2 enzymes represent a shared pathogenic pathway in psoriasis and pityriasis rubra pilaris. JCI Insight 2021; 6:e151911. [PMID: 34491907 PMCID: PMC8564909 DOI: 10.1172/jci.insight.151911] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/03/2021] [Indexed: 02/02/2023] Open
Abstract
Altered epidermal differentiation along with increased keratinocyte proliferation is a characteristic feature of psoriasis and pityriasis rubra pilaris (PRP). However, despite this large degree of overlapping clinical and histologic features, the molecular signatures these skin disorders share are unknown. Using global transcriptomic profiling, we demonstrate that plaque psoriasis and PRP skin lesions have high overlap, with all differentially expressed genes in PRP relative to normal skin having complete overlap with those in psoriasis. The major common pathway shared between psoriasis and PRP involves the phospholipases PLA2G2F, PLA2G4D, and PLA2G4E, which were found to be primarily expressed in the epidermis. Gene silencing each of the 3 PLA2s led to reduction in immune responses and epidermal thickness both in vitro and in vivo in a mouse model of psoriasis, establishing their proinflammatory roles. Lipidomic analyses demonstrated that PLA2s affect mobilization of a phospholipid-eicosanoid pool, which is altered in psoriatic lesions and functions to promote immune responses in keratinocytes. Taken together, our results highlight the important role of PLA2s as regulators of epidermal barrier homeostasis and inflammation, identify PLA2s as a shared pathogenic mechanism between PRP and psoriasis, and as potential therapeutic targets for both diseases.
Collapse
Affiliation(s)
- Shuai Shao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jiaoling Chen
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - William R Swindell
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Internal Medicine, the Jewish Hospital, Cincinnati, Ohio, USA
| | - Lam C Tsoi
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Xianying Xing
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Feiyang Ma
- Department of Dermatology, Department of Medicine, UCLA, Los Angeles, California, USA
| | - Ranjitha Uppala
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mrinal K Sarkar
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Olesya Plazyo
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Allison C Billi
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rachael Wasikowski
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Prisca Honore
- AbbVie Dermatology Discovery, North Chicago, Illinois, USA
| | | | - Emanual Maverakis
- Department of Dermatology, UC Davis School of Medicine, Sacramento, California, USA
| | - J Michelle Kahlenberg
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Nicole L Ward
- Departments of Nutrition and Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Paul W Harms
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | |
Collapse
|
23
|
Licata G, Gambardella A, Calabrese G, Pagliuca F, Alfano R, Argenziano G. Refractory Type I pityriasis rubra pilaris treated with tildrakizumab. Clin Exp Dermatol 2021; 46:1594-1595. [PMID: 34101231 DOI: 10.1111/ced.14790] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/16/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022]
Affiliation(s)
- G Licata
- Dermatology Unit, University of Campania, Luigi Vanvitelli, Naples, Italy
| | - A Gambardella
- Dermatology Unit, University of Campania, Luigi Vanvitelli, Naples, Italy
| | - G Calabrese
- Dermatology Unit, University of Campania, Luigi Vanvitelli, Naples, Italy
| | - F Pagliuca
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, University of Campania, Luigi Vanvitelli, Naples, Italy
| | - R Alfano
- Department of Anesthesiology, Surgery and Emergency, University of Campania Luigi Vanvitelli, Naples, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania, Luigi Vanvitelli, Naples, Italy
| |
Collapse
|
24
|
Simpson K, Dolianitis C. A case of treatment-resistant pityriasis rubra pilaris responsive to secukinumab. Australas J Dermatol 2021; 62:441-442. [PMID: 34028789 DOI: 10.1111/ajd.13614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/28/2021] [Accepted: 03/27/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Kate Simpson
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | | |
Collapse
|
25
|
Kettering C, Khosravi H, Ortiz C, English JC. Drug survival of systemic and biologic monotherapy treatments for pityriasis rubra pilaris: A retrospective observational study. J Am Acad Dermatol 2021; 86:1142-1143. [PMID: 33894320 DOI: 10.1016/j.jaad.2021.04.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/29/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | - Hasan Khosravi
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Camila Ortiz
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joseph C English
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
26
|
Duarte B, Paiva Lopes MJ. Response to: 'Successful treatment of refractory extensive pityriasis rubra pilaris with risankizumab'. Br J Dermatol 2021; 185:235-236. [PMID: 33730424 DOI: 10.1111/bjd.20061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/15/2021] [Indexed: 11/26/2022]
Affiliation(s)
- B Duarte
- Dermatology Department, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - M J Paiva Lopes
- Dermatology Department, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| |
Collapse
|
27
|
Pulsed dye laser as an adjunctive treatment for therapy-resistant pityriasis rubra pilaris. J Am Acad Dermatol 2020; 83:e391-e392. [DOI: 10.1016/j.jaad.2020.02.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 02/27/2020] [Indexed: 11/22/2022]
|
28
|
Liu T, Li S, Ying S, Tang S, Ding Y, Li Y, Qiao J, Fang H. The IL-23/IL-17 Pathway in Inflammatory Skin Diseases: From Bench to Bedside. Front Immunol 2020; 11:594735. [PMID: 33281823 PMCID: PMC7705238 DOI: 10.3389/fimmu.2020.594735] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Abstract
Interleukin-17 (IL-17) is an essential proinflammatory cytokine, which is mainly secreted by the CD4+ helper T cells (Th17 cells) and subsets of innate lymphoid cells. IL-17A is associated with the pathogenesis of inflammatory diseases, including psoriasis, atopic dermatitis, hidradenitis suppurativa, alopecia areata, pityriasis rubra pilaris, pemphigus, and systemic sclerosis. Interleukin-23 (IL-23) plays a pivotal role in stimulating the production of IL-17 by activating the Th17 cells. The IL-23/IL-17 axis is an important pathway for targeted therapy for inflammatory diseases. Emerging evidence from clinical trials has shown that monoclonal antibodies against IL-23, IL-17, and tumor necrosis factor are effective in the treatment of patients with psoriasis, atopic dermatitis, hidradenitis suppurativa, pityriasis rubra pilaris, pemphigus, and systemic sclerosis. Here, we summarize the latest knowledge about the biology, signaling, and pathophysiological functions of the IL-23/IL-17 axis in inflammatory skin diseases. The currently available biologics targeting the axis is also discussed.
Collapse
Affiliation(s)
- Taoming Liu
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sheng Li
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuni Ying
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shunli Tang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuwei Ding
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yali Li
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianjun Qiao
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Fang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
29
|
Camela E, Miano C, Di Caterino P, Lo Presti M, De Fata Salvatores G, Fabbrocini G, Megna M. Erythrodermic pityriasis rubra pilaris treatment: Two case reports and literature review. Dermatol Ther 2020; 33:e14223. [PMID: 32820849 DOI: 10.1111/dth.14223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 01/16/2023]
Abstract
Pityriasis rubra pilaris (PRP) is a rare inflammatory dermatosis characterized by hyperkeratotic follicular papules and erythematous-desquamative plaques that tend to progressively evolve into erythroderma. Treatment is challenging given that international guidelines are not available and large-scale trials do not exist. Traditionally, many topical and systemic drugs had been used as consolidated agents; recently, biologicals are gaining increasing importance, promisingly dominating the therapeutic scenario ahead. Herein, we present a case series showing the "past" and the "future" therapeutic approaches to erythrodermic PRP, one case treated with acitretin and nb-UVB phototherapy combination, while the other with ustekinumab, performing also a throughout literature review.
Collapse
Affiliation(s)
- Elisa Camela
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Chiara Miano
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Paola Di Caterino
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maurizio Lo Presti
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gaia De Fata Salvatores
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| |
Collapse
|
30
|
Penalba-Torres M, Pinilla-Martín B, Aragón-Miguel R, Velasco-Tamariz V, Rivera-Díaz R. Successful treatment of resistant pityriasis rubra pilaris with ixekizumab. Dermatol Ther 2020; 33:e13644. [PMID: 32441433 DOI: 10.1111/dth.13644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Maria Penalba-Torres
- Department of Dermatology, Hospital Universitario 12 de Octubre, I+12 Research Institute, Universidad Complutense, Madrid, Spain
| | - Belen Pinilla-Martín
- Department of Dermatology, Hospital Universitario 12 de Octubre, I+12 Research Institute, Universidad Complutense, Madrid, Spain
| | - Raquel Aragón-Miguel
- Department of Dermatology, Hospital Universitario 12 de Octubre, I+12 Research Institute, Universidad Complutense, Madrid, Spain
| | - Virginia Velasco-Tamariz
- Department of Dermatology, Hospital Universitario 12 de Octubre, I+12 Research Institute, Universidad Complutense, Madrid, Spain
| | - Raquel Rivera-Díaz
- Department of Dermatology, Hospital Universitario 12 de Octubre, I+12 Research Institute, Universidad Complutense, Madrid, Spain
| |
Collapse
|
31
|
Zhong Z, Li J, Xue R, Liang Y, Chen Y. Refractory classic juvenile pityriasis rubra pilaris successfully treated with a combination of etanercept and methotrexate. Dermatol Ther 2020; 33:e13431. [PMID: 32314486 DOI: 10.1111/dth.13431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/08/2020] [Accepted: 04/15/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Zemin Zhong
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Jingyi Li
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Ruzeng Xue
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Yunsheng Liang
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Yongfeng Chen
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
32
|
De Felice C, Graceffa D, Morrone A, Bonifati C. Familial pityriasis rubra pilaris successfully treated with brodalumab. Int J Dermatol 2020; 59:885-887. [DOI: 10.1111/ijd.14857] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/24/2020] [Accepted: 02/28/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Catia De Felice
- Centre for the Study and Treatment of Psoriasis at the Department of Clinical Dermatology San Gallicano Dermatological Institute IRCCS Rome Italy
| | - Dario Graceffa
- Centre for the Study and Treatment of Psoriasis at the Department of Clinical Dermatology San Gallicano Dermatological Institute IRCCS Rome Italy
| | - Aldo Morrone
- Scientific Direction San Gallicano Dermatological Institute IRCCS Rome Italy
| | - Claudio Bonifati
- Centre for the Study and Treatment of Psoriasis at the Department of Clinical Dermatology San Gallicano Dermatological Institute IRCCS Rome Italy
| |
Collapse
|
33
|
Naidoo A, Sibbald C, Fleming PJ, Piguet V. Use of Biologics in Pityriasis Rubra Pilaris Refractory to First-Line Systemic Therapy: A Systematic Review [Formula: see text]. J Cutan Med Surg 2019; 24:73-78. [PMID: 31691587 DOI: 10.1177/1203475419887731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Pityriasis rubra pilaris (PRP) is an uncommon, inflammatory, papulosquamous skin disease. Treatment of PRP is challenging as the disease is often refractory to conventional therapies, such as retinoids and methotrexate. There has been an increasing number of studies reporting the successful use of biologic therapy in patients with PRP; however, the data on the efficacy and safety are limited. Our objective was to evaluate the existing evidence for utilizing biologics, whether alone or in combination with established systemic therapies, in patients with treatment-resistant PRP. We systematically reviewed evidence within Medline and Pubmed databases between January 1, 2000, to March 31, 2019. Articles consisted of patients diagnosed with PRP who have failed to respond sufficiently to first-line systemic therapies, or who had comorbidities that precluded their use. In total, 363 unique articles were identified, 56 of which were considered relevant to the clinical question. Of the 56 articles highlighted, 35 met the inclusion criteria and were limited to case series and case studies. Therapy with biologics was found to be successful for both monotherapy (81.1% [27/33]) and when used in combination with existing systemic therapies (87.5% [14/16]). The existing evidence suggests that biologics may be regarded as a tool for PRP treatment alone or in combination therapy with existing treatments, although large-scale randomized clinical trials are necessary to better assess their efficacy and safety.
Collapse
Affiliation(s)
- Avee Naidoo
- 12366 210484 Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - Cathryn Sibbald
- 6567 Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Patrick J Fleming
- 12366 210484 Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - Vincent Piguet
- 12366 210484 Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada.,7938 Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, ON, Canada
| |
Collapse
|
34
|
Maloney NJ, Kim MM, Nguyen KA, Hisaw LD, Worswick S. Patient experiences with biologics and apremilast in pityriasis rubra pilaris: A patient survey. Dermatol Ther 2019; 32:e13060. [DOI: 10.1111/dth.13060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/01/2019] [Accepted: 08/06/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Nolan J. Maloney
- Division of Dermatology, Department of MedicineDavid Geffen School of Medicine at UCLA Los Angeles California
| | - Mindy M. Kim
- Division of Hematology and Oncology, Department of MedicineDavid Geffen School of Medicine at UCLA Los Angeles California
| | - Kevin A. Nguyen
- Division of Dermatology, Department of MedicineDavid Geffen School of Medicine at UCLA Los Angeles California
| | - Lisa D. Hisaw
- Kaiser Permanente, Northern California Dermatology Oakland California
| | - Scott Worswick
- Department of DermatologyUniversity of Southern California Los Angeles California
| |
Collapse
|
35
|
Speeckaert R, Lambert J, van Geel N. Learning From Success and Failure: Biologics for Non-approved Skin Diseases. Front Immunol 2019; 10:1918. [PMID: 31440261 PMCID: PMC6694799 DOI: 10.3389/fimmu.2019.01918] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/29/2019] [Indexed: 12/14/2022] Open
Abstract
The impressive potential of biologics has been demonstrated in psoriasis, hidradenitis suppurativa, and urticaria. Numerous biologicals are entering the field for a restricted number of skin disorders. Off-label use of biologics in other recalcitrant skin diseases has increased. Mounting data point to the potential of already existing biologics acting on the IL-17/IL-23 pathway in skin disorders with epidermal hyperkeratosis (e.g., pityriasis rubra pilaris), acneiform inflammation (e.g., hidradenitis suppurativa), and loss of mucosal integrity (e.g., aphthosis). TNF-α blockers are also effective in the latter conditions but seem of particular value in granulomatous (e.g., granuloma annulare) and neutrophilic disorders (e.g., pyoderma gangrenosum). Failure of IL-17 blockade in skin diseases resulting from immune-mediated cell destruction (e.g., alopecia areata and vitiligo) illustrates its limited involvement in Th1-dependent skin immunology. Overall, disappointing results of TNF-α blockers in alopecia areata and vitiligo point to the same conclusion although promising results in toxic epidermal necrolysis suggest TNF-α exerts at least some in vivo Th1-related activities. Acting on both the Th1 and Th17 pathway, ustekinumab has a rather broad potential with interesting results in lupus and alopecia areata. The efficacy of omalizumab in bullous pemphigoid has revealed an IgE-mediated recruitment of eosinophils leading to bullae formation. Reconsidering reimbursement criteria for less common but severe diseases seems appropriate if substantial evidence is available (e.g., pityriasis rubra pilaris). For other disorders, investigator- and industry-initiated randomized clinical trials should be stimulated. They are likely to improve patient outcome and advance our understanding of challenging skin disorders.
Collapse
Affiliation(s)
| | - Jo Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
36
|
Abstract
Pityriasis rubra pilaris (PRP) is a rare inflammatory skin disorder of unknown etiology, initially described in 1835. It is characterized by keratotic follicular papules, well-demarcated salmon-colored erythematous scaly plaques interspersed with distinct islands of uninvolved skin, and palmoplantar keratoderma. Is PRP a systemic disease? Skin is mainly affected in PRP. Despite its clinical heterogeneity, PRP could be associated with a variety of rheumatologic, infectious, neoplastic, and other extracutaneous manifestations. We accept the hypothesis of not only an association but also a causative relation between skin and systemic manifestations with possible common underlying pathomechanisms such as systemic immunologic processes and superantigen mimicry.
Collapse
|
37
|
Sarles C, Valois A, Abed S, Boyé T, Fouet B, Morand JJ. [Pityriasis rubra pilaris: 3 cases with biologics]. Ann Dermatol Venereol 2019; 146:304-306. [PMID: 30929873 DOI: 10.1016/j.annder.2019.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/21/2018] [Accepted: 01/23/2019] [Indexed: 01/12/2023]
Affiliation(s)
- C Sarles
- Service de dermatologie, hôpital d'instruction des armées, 83800 Toulon, France
| | - A Valois
- Service de dermatologie, hôpital d'instruction des armées, 83800 Toulon, France
| | - S Abed
- Service de dermatologie, hôpital d'instruction des armées, 83800 Toulon, France
| | - T Boyé
- Service de dermatologie, hôpital d'instruction des armées, 83800 Toulon, France
| | - B Fouet
- Service d'anatomopathologie, hôpital d'instruction des armées, 83800 Toulon, France
| | - J-J Morand
- Service de dermatologie, hôpital d'instruction des armées, 83800 Toulon, France.
| |
Collapse
|