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Costin D, Burlui AM, Cardoneanu A, Macovei LA, Rezus C, Bratoiu I, Richter P, Mihai IR, Gherasim A, Danielescu C, Rezus E. Paradoxical Psoriasis in Patients Receiving Therapy with Tumor Necrosis Factor Inhibitors: Potential Pathogenic Mechanisms and the Role of Genetic Factors. Int J Mol Sci 2024; 25:7018. [PMID: 39000125 PMCID: PMC11241744 DOI: 10.3390/ijms25137018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/18/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024] Open
Abstract
TNF inhibitors (TNFi) have revolutionized the therapeutic management of various chronic immune-mediated inflammatory diseases. Despite their known benefits, these therapies are related to paradoxical adverse effects (PAEs), including paradoxical psoriasis (PP). Although the underlying mechanism remains somewhat unclear, some theories suggest that genetic factors, particularly certain single-nucleotide polymorphisms (SNPs), may play an important role. The present review aimed to research and analyze recent findings regarding the pathomechanisms involved in the appearance of PP and the association between various genetic factors and PP in individuals treated with TNFi. We performed a literature search and found that certain genes (IL23R, TNF, FBXL19, CTLA4, SLC12A8, TAP1) are strongly associated with the occurrence of PP in pediatric and adult patients during therapy with TNFi. The identification of the specific SNPs involved in the appearance of PP and other PAEs in patients treated with TNFi for various diseases and in different populations may later favor the recognition of those patients at a high risk of developing such adverse effects and could guide personalized therapeutic strategies in future years.
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Affiliation(s)
- Damiana Costin
- Department of Medical Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.); (A.C.); (L.A.M.); (I.B.); (P.R.); (I.R.M.); (A.G.); (E.R.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Alexandra Maria Burlui
- Department of Medical Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.); (A.C.); (L.A.M.); (I.B.); (P.R.); (I.R.M.); (A.G.); (E.R.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Anca Cardoneanu
- Department of Medical Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.); (A.C.); (L.A.M.); (I.B.); (P.R.); (I.R.M.); (A.G.); (E.R.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Luana Andreea Macovei
- Department of Medical Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.); (A.C.); (L.A.M.); (I.B.); (P.R.); (I.R.M.); (A.G.); (E.R.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- “Sfantul Spiridon” Emergency Hospital, 700111 Iasi, Romania
| | - Ioana Bratoiu
- Department of Medical Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.); (A.C.); (L.A.M.); (I.B.); (P.R.); (I.R.M.); (A.G.); (E.R.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Patricia Richter
- Department of Medical Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.); (A.C.); (L.A.M.); (I.B.); (P.R.); (I.R.M.); (A.G.); (E.R.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ioana Ruxandra Mihai
- Department of Medical Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.); (A.C.); (L.A.M.); (I.B.); (P.R.); (I.R.M.); (A.G.); (E.R.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Andreea Gherasim
- Department of Medical Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.); (A.C.); (L.A.M.); (I.B.); (P.R.); (I.R.M.); (A.G.); (E.R.)
- “Sfantul Spiridon” Emergency Hospital, 700111 Iasi, Romania
| | - Ciprian Danielescu
- Department of Surgery II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Profesor Dr. Nicolae Oblu” Clinical Emergency Hospital, 700309 Iasi, Romania
| | - Elena Rezus
- Department of Medical Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.C.); (A.C.); (L.A.M.); (I.B.); (P.R.); (I.R.M.); (A.G.); (E.R.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
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Chaudet KM, Russell-Goldman E, Horn TD, Schuler AM, Chan MP, Nazarian RM. Characterization of T-Helper Immune Phenotype in Symmetrical Drug-Related Intertriginous and Flexural Exanthema (SDRIFE) Endorses a Delayed-Type Hypersensitivity Reaction. Am J Dermatopathol 2024; 46:71-78. [PMID: 38133537 DOI: 10.1097/dad.0000000000002455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
ABSTRACT Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is a cutaneous drug eruption with a characteristic distribution of erythema on the gluteal/inguinal region and intertriginous areas with unclear pathogenesis. In this study, we aimed to characterize the T-helper immune phenotype in SDRIFE in comparison with psoriasis and eczema to further the understanding of the pathophysiology and immune response of this rare disorder. Immunohistochemical staining was performed on 9 skin biopsies each from SDRIFE, psoriasis, and eczema using immunohistochemistry for CD3 and dual CD4/T-bet, CD4/GATA3, and CD4/RORC to quantify the percentage of Th1, Th2, and Th17 cells, respectively. A significant difference was detected in the average percentage of Th1 between all 3 groups with the highest percentage of Th1 cells seen in psoriasis, followed by SDRIFE and eczema. SDRIFE showed significantly lower Th2 expression as compared to both psoriasis and eczema. There was a trend towards a higher average percentage of Th17 in psoriasis and SDRIFE, and the ratio of Th17:Th2 was significantly higher in samples of SDRIFE compared with both eczema and psoriasis. The findings characterize SDRIFE as a Th1 and possibly Th17-driven process, which could inform future therapeutic options and substantiate the model of SDRIFE as a delayed-type hypersensitivity reaction.
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Affiliation(s)
- Kristine M Chaudet
- Pathologist, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Eleanor Russell-Goldman
- Pathologist, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston MA
| | - Thomas D Horn
- Pathologist, Departments of Dermatology and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; and
| | - Amy M Schuler
- Pathologist, Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - May P Chan
- Pathologist, Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Rosalynn M Nazarian
- Pathologist, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Lu J, Lu Y. Paradoxical psoriasis: The flip side of idiopathic psoriasis or an autocephalous reversible drug reaction? J Transl Autoimmun 2023; 7:100211. [PMID: 37731549 PMCID: PMC10507642 DOI: 10.1016/j.jtauto.2023.100211] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/21/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023] Open
Abstract
Psoriasis is a common, chronic skin disease that results mainly from the complex interplay between T cells, dendritic cells, and inflammatory cytokines including TNF-α, IL-17, IL-12, and IL-23. Successful therapy with anti-cytokine antibodies has proved the importance of these key cytokines, especially TNF-α. During the anti-TNF-α treatment of classical idiopathic psoriasis, a small portion of patients develop new psoriasiform lesions. This contradictory phenomenon was named paradoxical psoriasis which resembles idiopathic psoriasis clinically but presents overlapped histological patterns and distinct immunological processes. In this review, we discuss the differences between idiopathic psoriasis and paradoxical psoriasis with an emphasis on their innate immunity, as it is predominant in paradoxical psoriasis which exhibits type I IFN-mediated immunity without the activation of autoreactive T cells and memory T cells. We also put up an instructive algorithm for the management of paradoxical psoriasis. The decision on drug discontinuation or switching of biologics should be made based on the condition of underlying diseases and the severity of lesions.
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Affiliation(s)
- Jiawei Lu
- Department of Dermatology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, PR China
| | - Yan Lu
- Department of Dermatology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, PR China
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Cytokines and apoptosis in atopic dermatitis. Postepy Dermatol Alergol 2021; 38:1-13. [PMID: 34408560 PMCID: PMC8362769 DOI: 10.5114/ada.2019.88394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/29/2019] [Indexed: 02/06/2023] Open
Abstract
Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. AD affects 10-20% of children worldwide and persists into adulthood in a minority of cases, affecting approximately 2-3% of the adult population, with an increased prevalence over the past decades in developed countries. Atopy is a genetic tendency to overproduce IgE class antibodies in response to common antigens found in the environment. Concurrence of different atopy such as allergic rhinitis or asthma in children with AD is estimated at 80%. AD is characterized by a vicious cycle of an allergic immune response. The emerging picture of the AD is a complex disorder with barrier dysfunction, immunological, genetic and environmental factors all playing key roles. Patients with severe or persistent disease and their families experience significant impairment in their quality of life, and in addition, AD places a heavy economic burden on society as a whole. Pathogenesis, the role of the epidermal barrier, mechanisms of cells apoptosis, the role of T cells and cytokines in AD are discussed in this article.
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Navarro R, Delgado-Jiménez Y, Guinea-Viniegra J, Llamas-Velasco M, Daudén E. Expression of microRNA-21 and TIMP-3 in paradoxical psoriasiform reactions during treatment with antitumor necrosis factor agents. J Cutan Pathol 2021; 49:116-122. [PMID: 34322902 DOI: 10.1111/cup.14113] [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: 11/10/2020] [Revised: 06/08/2021] [Accepted: 07/12/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Expression of microRNA-21 (miR-21) is increased in psoriasis, leading to reduced levels of epidermal tissue inhibitor of matrix metalloproteinase 3 (TIMP-3), a highly potent inhibitor of the tumor necrosis factor alpha (TNFα) sheddase TACE (TNFα-converting enzyme)/ADAM17. We described the profile of miR-21 and TIMP-3 in paradoxical psoriasiform reactions induced by anti-TNFα drugs and in a control group to elucidate the pathogenesis of this reactions. METHODS We performed an analytic, cross-sectional, prospective, experimental case-control study. We compared our findings with those of non-induced psoriasis. RESULTS We included 15 patients with a change of morphology (plaque to guttate psoriasis) and 10 patients with induced psoriasis (six palmoplantar pustulosis and four plaque psoriasis). Consecutive patients with different subtypes of non-induced, non-systemically treated psoriasis were included as a control group. We found that most cases with guttate psoriasis and with induced plaque psoriasis cases showed high expression of TIMP-3 expression and decreased or poorly increased levels of miR-21. The expression pattern was not homogeneous in the cases of induced palmoplantar pustulosis. These profiles differ from those of non-induced psoriasis. CONCLUSION We conclude that various pro-inflammatory cytokine profiles are involved in the pathogenesis of paradoxical psoriasiform reactions and non-induced psoriasis.
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Affiliation(s)
- Raquel Navarro
- Department of Dermatology, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Yolanda Delgado-Jiménez
- Department of Dermatology, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | | | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Esteban Daudén
- Department of Dermatology, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
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Tan TL, Taglia L, Yazdan P. Drug-induced psoriasiform alopecia associated with interleukin-17 inhibitor therapy. J Cutan Pathol 2021; 48:771-774. [PMID: 33389767 DOI: 10.1111/cup.13952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 12/07/2020] [Accepted: 12/29/2020] [Indexed: 12/26/2022]
Abstract
Drug-induced psoriasiform alopecia is an increasingly recognized form of alopecia mostly reported in association with TNF-alpha inhibitors. However, drug-induced psoriasiform alopecia in association with IL-17A inhibitors has not been described. We present a 62-year-old woman with severe psoriasis who developed new psoriatic plaques on the scalp with alopecia after initiating ixekizumab (anti-IL-17A). Scalp biopsy specimens revealed a non-cicatricial alopecia with increased telogen/catagen follicles, atrophy of the sebaceous glands, peribulbar and perifollicular inflammation with frequent lymphocytes, plasma cells, eosinophils, psoriasiform dermatitis, and lack of intra-corneal or intra-epidermal neutrophils. Overall, the clinical and histopathologic findings were most compatible with a drug-induced psoriasiform alopecia in association with IL-17A inhibitor therapy. Our case shows that drug-induced psoriasiform alopecia can paradoxically occur in patients on IL-17A inhibitor therapy and contributes to the growing list of cutaneous eruptions associated with biologic agents.
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Affiliation(s)
- Timothy L Tan
- Consolidated Pathology Consultants, Libertyville, Illinois, USA
| | - Lauren Taglia
- Department of Dermatology, Northwestern Medicine Regional Medical Group, Naperville, Illinois, USA
| | - Pedram Yazdan
- Division of Dermatopathology, Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Navarro R, Villar-Zarra K, Juarez Á, Daudén E. Histopathologic study of paradoxical psoriasis induced by antitumor necrosis factor alpha therapy: Is it true psoriasis? J Cutan Pathol 2020; 48:813-816. [PMID: 33205481 DOI: 10.1111/cup.13919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/31/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Raquel Navarro
- Department of Dermatology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Karen Villar-Zarra
- Department of Pathology, Hospital Universitario La Princesa, Madrid, Spain
| | - África Juarez
- Department of Dermatology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Esteban Daudén
- Department of Dermatology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
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Boggs JME, Ramsay B, Lynch M. Paradoxical psoriasis caused by tumour necrosis factor inhibitor therapy. Clin Exp Dermatol 2020; 46:580-582. [PMID: 33151572 DOI: 10.1111/ced.14500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 11/29/2022]
Affiliation(s)
- J M E Boggs
- Charles Centre Department of Dermatology, University Hospital Limerick, Limerick, Ireland
| | - B Ramsay
- Charles Centre Department of Dermatology, University Hospital Limerick, Limerick, Ireland
| | - M Lynch
- Charles Centre Department of Dermatology, University Hospital Limerick, Limerick, Ireland
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Recent Advances in Psoriasis Research; the Clue to Mysterious Relation to Gut Microbiome. Int J Mol Sci 2020; 21:ijms21072582. [PMID: 32276410 PMCID: PMC7177330 DOI: 10.3390/ijms21072582] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 12/13/2022] Open
Abstract
Psoriasis is a chronic inflammatory cutaneous disease, characterized by activated plasmacytoid dendritic cells, myeloid dendritic cells, Th17 cells, and hyperproliferating keratinocytes. Recent studies revealed skin-resident cells have pivotal roles in developing psoriatic skin lesions. The balance in effector T cells and regulatory T cells is disturbed, leading Foxp3-positive regulatory T cells to produce proinflammatory IL-17. Not only acquired but also innate immunity is important in psoriasis pathogenesis, especially in triggering the disease. Group 3 innate lymphoid cell are considered one of IL-17-producing cells in psoriasis. Short chain fatty acids produced by gut microbiota stabilize expression of Foxp3 in regulatory T cells, thereby stabilizing their function. The composition of gut microbiota influences the systemic inflammatory status, and associations been shown with diabetes mellitus, cardiovascular diseases, psychomotor diseases, and other systemic inflammatory disorders. Psoriasis has been shown to frequently comorbid with diabetes mellitus, cardiovascular diseases, psychomotor disease and obesity, and recent report suggested the similar abnormality in gut microbiota as the above comorbid diseases. However, the precise mechanism and relation between psoriasis pathogenesis and gut microbiota needs further investigation. This review introduces the recent advances in psoriasis research and tries to provide clues to solve the mysterious relation of psoriasis and gut microbiota.
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Cohen JN, Bowman S, Laszik ZG, North JP. Clinicopathologic overlap of psoriasis, eczema, and psoriasiform dermatoses: A retrospective study of T helper type 2 and 17 subsets, interleukin 36, and β-defensin 2 in spongiotic psoriasiform dermatitis, sebopsoriasis, and tumor necrosis factor α inhibitor-associated dermatitis. J Am Acad Dermatol 2019; 82:430-439. [PMID: 31859047 DOI: 10.1016/j.jaad.2019.08.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 07/24/2019] [Accepted: 08/07/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND T helper (Th) type 17 and Th2 cells mediate psoriasis and eczema, respectively. Some dermatoses exhibit overlapping clinicopathologic features, and their immunopathology is relatively unexplored. OBJECTIVE To determine whether Th17 and Th2 subsets and interleukin (IL) 36 and β-defensin 2 (BD-2) markers of IL-17 signaling expression can discriminate between biopsy samples of psoriasis and eczematous/spongiotic dermatitis and to use those markers to immunophenotype cases with clinicopathologic overlap. METHODS A retrospective study was performed on biopsy samples of psoriasis, eczema/spongiotic dermatitis, sebopsoriasis, tumor necrosis factor α inhibitor-associated psoriasiform dermatitis, and ambiguous cases diagnosed as spongiotic psoriasiform dermatitis. Dual CD4/GATA3 and CD4/RORC, IL-36, and BD-2 immunohistochemistry was performed. RESULTS IL-36 and BD-2 were strongly expressed in biopsy samples of psoriasis compared with eczema/spongiotic dermatitis. No significant differences were observed in the percentages of Th2 and Th17 cells between disease types. Strong expression of IL-36 and BD-2 was observed in a subset of spongiotic psoriasiform dermatitis, sebopsoriasis, and tumor necrosis factor α inhibitor-associated psoriasiform dermatitis biopsy samples. LIMITATIONS This was an exploratory study with a small sample size. No multiple testing adjustment was done. Clinical follow-up was limited. CONCLUSIONS In cases with clinicopathologic overlap between psoriasis and spongiotic dermatitis, IL-36, and to a lesser extent BD-2, may be used to assess for a psoriasis-like/IL-17 phenotype, which could inform therapeutic clinical decisions.
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Affiliation(s)
- Jarish N Cohen
- Department of Pathology, University of California, San Francisco, CA; Department of Dermatology, University of California, San Francisco, CA; UCSF Dermatopathology Service, University of California, San Francisco, CA
| | - Sarah Bowman
- Department of Pathology, University of California, San Francisco, CA; UCSF Dermatopathology Service, University of California, San Francisco, CA
| | - Zoltan G Laszik
- Department of Pathology, University of California, San Francisco, CA; UCSF Dermatopathology Service, University of California, San Francisco, CA
| | - Jeffrey P North
- Department of Pathology, University of California, San Francisco, CA; Department of Dermatology, University of California, San Francisco, CA; UCSF Dermatopathology Service, University of California, San Francisco, CA.
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Enrichment of Polyfunctional IL-17-Producing T Cells in Paradoxical Psoriasis Skin Lesions. J Invest Dermatol 2019; 140:1094-1097. [PMID: 31682840 DOI: 10.1016/j.jid.2019.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/18/2019] [Accepted: 10/22/2019] [Indexed: 11/21/2022]
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