1
|
Lim DZJ, Tey HL, Lim JHL. Amicrobial pustulosis of the folds with peculiar palmoplantar involvement. Australas J Dermatol 2022; 63:e273-e276. [PMID: 35674386 DOI: 10.1111/ajd.13886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Hong Liang Tey
- National Skin Centre, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | |
Collapse
|
2
|
Balaguer-Franch I, Hernández de la Torre-Ruiz E, Lacasta-Plasin C, García-Piqueras P, Menchén-Viso L, Baniandrés-Rodríguez O. Pustular lesions in patients with Crohn disease and treatment with tumour necrosis factor-α inhibitors. Clin Exp Dermatol 2021; 47:453-455. [PMID: 34431537 DOI: 10.1111/ced.14909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 11/27/2022]
Abstract
We present seven new cases of patients with Crohn disease who developed lesions clinically compatible with amicrobial pustulosis of the flexures during their treatment with anti-tumour necrosis factor therapy.
Collapse
Affiliation(s)
- I Balaguer-Franch
- Dermatology, Centro de Enfermedades Inflamatorias Mediadas por la Inmunidad, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - E Hernández de la Torre-Ruiz
- Dermatology, Centro de Enfermedades Inflamatorias Mediadas por la Inmunidad, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - C Lacasta-Plasin
- Dermatology, Centro de Enfermedades Inflamatorias Mediadas por la Inmunidad, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - P García-Piqueras
- Dermatology, Centro de Enfermedades Inflamatorias Mediadas por la Inmunidad, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - L Menchén-Viso
- Gastroenterology Service, Centro de Enfermedades Inflamatorias Mediadas por la Inmunidad, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Department of Medicine, Universidad Complutense, Madrid, Spain.,Network Biomedical Research Center for Liver and Digestive Diseases (CIBEREHD), Madrid, Spain
| | - O Baniandrés-Rodríguez
- Dermatology, Centro de Enfermedades Inflamatorias Mediadas por la Inmunidad, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Department of Medicine, Universidad Complutense, Madrid, Spain
| |
Collapse
|
3
|
Feldmeyer L, Ribero S, Gloor AD, Borradori L. Neutrophilic dermatoses with unusual and atypical presentations. Clin Dermatol 2020; 39:261-270. [PMID: 34272020 DOI: 10.1016/j.clindermatol.2020.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Neutrophilic dermatoses (NDs) are a group of reactive, noninfectious autoinflammatory diseases characterized by (1) infiltration of the epidermis, dermis, and or/hypodermis by neutrophils; (2) their association with distinct diseases (eg, hematologic malignancy and chronic inflammatory diseases); (3) potential extracutaneous involvement; and (4) response to anti-inflammatory drugs, such as corticosteroids, dapsone, colchicine, and novel biologic therapies, such as the anti-interleukin-1 blockade. Although distinct NDs have been described, transitional forms with overlapping features are often identified. These justify a simplified classification of NDs with three major forms: superficial (epidermal or pustular) NDs, dermal (en plaques) NDs, and deep NDs. We review selected or novel variants of NDs, including subcorneal pustular dermatosis, the group of immunoglobulin A neutrophilic dermatoses, amicrobial pustular dermatosis of the folds, and neutrophilic urticarial dermatosis, as well as atypical forms of Sweet syndrome and pyoderma gangrenosum closely mimicking severe infectious diseases. Knowledge of these variants is essential for proper diagnosis, adequate management, and avoidance of a dangerous escalation of therapy, such as unnecessary immunosuppression or extensive surgery.
Collapse
Affiliation(s)
- Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Simone Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Andrea D Gloor
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luca Borradori
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
4
|
Facheris P, De Santis M, Gargiulo L, Pavia G, Valenti M, Manara S, Borroni RG, Costanzo A, Narcisi A. Concomitant Pyoderma Gangrenosum-like and Amicrobial Pustulosis of the Folds: a Case Report. J Clin Immunol 2020; 40:1038-1040. [PMID: 32648026 PMCID: PMC7505873 DOI: 10.1007/s10875-020-00819-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Paola Facheris
- Department of Dermatology, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy. .,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
| | - Maria De Santis
- Department of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center-IRCCS, Rozzano, MI, Italy
| | - Luigi Gargiulo
- Department of Dermatology, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Giulia Pavia
- Department of Dermatology, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Mario Valenti
- Department of Dermatology, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Sofia Manara
- Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano, MI, Italy
| | - Riccardo G Borroni
- Department of Dermatology, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Antonio Costanzo
- Department of Dermatology, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Alessandra Narcisi
- Department of Dermatology, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy
| |
Collapse
|
5
|
Mesnard C, Aubert H, Bourreille A, Trang C, Gagey-Caron V, Le Corre Y, Topin Ruiz S, Barbarot S. The triangular nasal notch sign in patients with Crohn disease treated with tumour necrosis factor inhibitors. Br J Dermatol 2019; 181:1103-1104. [PMID: 31145467 DOI: 10.1111/bjd.18176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- C Mesnard
- Department of Dermatology, CHU Nantes, 44800, Nantes, France
| | - H Aubert
- Department of Dermatology, CHU Nantes, 44800, Nantes, France
| | - A Bourreille
- Department of Gastroenterology, CHU Nantes, 44800, Nantes, France
| | - C Trang
- Department of Gastroenterology, CHU Nantes, 44800, Nantes, France
| | | | - Y Le Corre
- Department of Dermatology, CHU Angers, France
| | | | - S Barbarot
- Department of Dermatology, CHU Nantes, 44800, Nantes, France
| |
Collapse
|
6
|
Ribero S, Sciascia S, Borradori L, Lipsker D. The Cutaneous Spectrum of Lupus Erythematosus. Clin Rev Allergy Immunol 2018; 53:291-305. [PMID: 28752372 DOI: 10.1007/s12016-017-8627-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Systemic lupus erythematosus is a complex autoimmune disease with a wide spectrum of clinical and immunopathological features. Cutaneous and articular manifestations are the most common signs in patients with systemic lupus erythematosus. We here review the pathogenesis and the new classification of cutaneous lupus erythemathosus with a discussion of the significance of the various cutaneous signs. The lesions are classified according to the level of the cellular infiltrate and tissue damage in the epidermis, dermis, and/or subcutis. Furthermore, cutaneous lesions pointing to the presence of a thrombotic vasculopathy and those due to a distinct inflammatory, neutrophilic-mediated reaction pattern are highlighted. Particular attention will be given in describing the histology of skin manifestation. Treatment options for cutaneous lupus erythemathosus have increased with the introduction of new biological therapies. However, the majority of the patients still benefit from antimalarials, which remain the cornerstone of treatment. The evaluation and management of cutaneous lupus erythemathosus patients depend on the clinical findings and associated symptoms.
Collapse
Affiliation(s)
- Simone Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy.
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases- Department of Clinical and Biological Sciences, University of Turin, San Giovanni Hospital, Turin, Italy
| | - Luca Borradori
- Department of Dermatology, University of Bern, Inselspital, Berne, Switzerland
| | - Dan Lipsker
- Dermatologic Clinic, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| |
Collapse
|
7
|
[Cell-mediated immunity: Lupus and connective tissue diseases]. Ann Pathol 2018; 38:43-54. [PMID: 29290386 DOI: 10.1016/j.annpat.2017.10.012] [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: 10/22/2017] [Accepted: 10/26/2017] [Indexed: 11/21/2022]
Abstract
Lupus can present itself in a multitude of clinical and histopathological manifestations. Cutaneous lesions can be very variable either from the clinical point of view or at the microscopic scale. Signs can be specific, concerning the dermo-epidermal stage, the dermal stage or the hypodermal stage. Conversely, some manifestations can be not specific but associated to the lupus. Finally, the question of the differential diagnosis can be tricky and often requires a beam of clinical, biological and histopathological arguments.
Collapse
|
8
|
Zirwas M, Dobkin HE, Krishnamurthy S. Amicrobial pustulosis of the folds and palmoplantar pustulosis simultaneously induced by different tumor necrosis factor-α inhibitors: Demonstration of a shared pathophysiology. JAAD Case Rep 2017; 3:401-403. [PMID: 28879224 PMCID: PMC5581848 DOI: 10.1016/j.jdcr.2017.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Hershel E Dobkin
- Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | | |
Collapse
|
9
|
Marzano AV, Borghi A, Wallach D, Cugno M. A Comprehensive Review of Neutrophilic Diseases. Clin Rev Allergy Immunol 2017; 54:114-130. [DOI: 10.1007/s12016-017-8621-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
10
|
Schissler C, Velter C, Lipsker D. Amicrobial pustulosis of the folds: Where have we gone 25 years after its original description? Ann Dermatol Venereol 2017; 144:169-175. [DOI: 10.1016/j.annder.2016.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/07/2016] [Accepted: 10/28/2016] [Indexed: 12/13/2022]
|
11
|
Palmoplantar pustulosis by adalimumab in a patient with Crohn disease. Med Clin (Barc) 2016; 147:565. [PMID: 27431884 DOI: 10.1016/j.medcli.2016.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/19/2016] [Indexed: 11/21/2022]
|
12
|
Marzano AV, Tavecchio S, Berti E, Gelmetti C, Cugno M. Cytokine and Chemokine Profile in Amicrobial Pustulosis of the Folds: Evidence for Autoinflammation. Medicine (Baltimore) 2015; 94:e2301. [PMID: 26683967 PMCID: PMC5058939 DOI: 10.1097/md.0000000000002301] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Autoinflammation has recently been suggested in the pathogenesis of neutrophilic dermatoses but systematic studies on their cytokine profile are lacking. Notably, amicrobial pustulosis of the folds (APF), classified among neutrophilic dermatoses, has been studied only in small case series. In our University Hospital, we conducted an observational study on 15 APF patients, analyzing their clinical and laboratory features with a follow-up of 9 months to 20 years. Skin cytokine pattern of 9 of them was compared to that of 6 normal controls. In all patients, primary lesions were pustules symmetrically involving the skin folds and anogenital region with a chronic-relapsing course and responding to corticosteroids. Dapsone, cyclosporine, and tumor necrosis factor blockers were effective in refractory cases. In skin samples, the expressions of interleukin (IL)-1β, pivotal cytokine in autoinflammation, and its receptors I and II were significantly higher in APF (P = 0.005, 0.018, and 0.034, respectively) than in controls. Chemokines responsible for neutrophil recruitment such as IL-8 (P = 0.003), CXCL 1/2/3 (C-X-C motif ligand 1/2/3) (P = 0.010), CXCL 16 (P = 0.045), and RANTES (regulated on activation, normal T cell expressed and secreted) (P = 0.034) were overexpressed. Molecules involved in tissue damage like matrix metalloproteinase-2 (MMP-2) (P = 0.010) and MMP-9 (P = 0.003) were increased. APF is a pustular neutrophilic dermatosis with a typical distribution in all patients. The disorder may coexist with an underlying autoimmune/dysimmune disease but is often associated only with a few autoantibodies without a clear autoimmunity. The overexpression of cytokines/chemokines and molecules amplifying the inflammatory network supports the view that APF has an important autoinflammatory component.
Collapse
Affiliation(s)
- Angelo V Marzano
- From the Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy (AVM, ST, EB, CG) and Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Medicina Interna, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy (MC)
| | | | | | | | | |
Collapse
|
13
|
Pustular Skin Reaction to Tumor Necrosis Factor Alpha Antagonists in Patients with Inflammatory Bowel Diseases. Inflamm Bowel Dis 2015; 21:E26-7. [PMID: 26422518 DOI: 10.1097/mib.0000000000000600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
14
|
Marzano AV, Tavecchio S, Berti E, Gelmetti C, Cugno M. Paradoxical Autoinflammatory Skin Reaction to Tumor Necrosis Factor Alpha Blockers Manifesting as Amicrobial Pustulosis of the Folds in Patients With Inflammatory Bowel Diseases. Medicine (Baltimore) 2015; 94:e1818. [PMID: 26559252 PMCID: PMC4912246 DOI: 10.1097/md.0000000000001818] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The therapy of inflammatory bowel disease, particularly with tumor necrosis factor (TNF) blockers, may be associated with a number of cutaneous adverse effects, including psoriasis-like, eczema-like, and lichenoid eruptions. Other rare skin complications are neutrophilic dermatoses such as amicrobial pustulosis of the folds (APF), which is a chronic relapsing pustular disorder classified in this spectrum.The authors analyzed clinical, histopathologic, and cytokine expression profiles of 3 inflammatory bowel disease patients with APF triggered by adalimumab (patient 1) and infliximab (patients 2 and 3).All 3 patients presented with sterile pustules involving the cutaneous folds, genital regions, and scalp 6 months after starting adalimumab (patient 1) and 9 months after starting infliximab (patients 2 and 3). Histology was characterized by epidermal spongiform pustules with a dermal neutrophilic and lymphocytic infiltrate. Tumor necrosis factor blocker withdrawal associated with topical and systemic corticosteroids induced complete remission of APF in all 3 patients. The expressions of interleukin (IL)-1 beta and its receptors as well as TNF alpha and its receptors were significantly higher in APF than in controls. Also IL-17, leukocyte selectin, and chemokines, such as IL-8, [C-X-C motif] chemokine ligand 1/2/3 (C = cysteine, X = any amino acid), [C-X-C motif] chemokine ligand 16 (C = cysteine, X = any amino acid), and RANTES (regulated on activation, normal T cell expressed and secreted) were significantly overexpressed. Finally, the authors found significant overexpression of both metalloproteinases 2/9 and their inhibitors 1/2.The observation of 3 patients with APF following anti-TNF therapy expands not only the clinical context of APF but also the spectrum of anti-TNF side effects. Overexpression of cytokines/chemokines and molecules amplifying the inflammatory network supports the view that APF is autoinflammatory in origin.
Collapse
Affiliation(s)
- Angelo V Marzano
- From the Dermatology Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Cà Granda Foundation, Milan, Italy (AVM, ST, EB, CG) and Internal Medicine Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Cà Granda Foundation, Milan, Italy (MC)
| | | | | | | | | |
Collapse
|
15
|
Hau E, Vignon Pennamen MD, Battistella M, Saussine A, Bergis M, Cavelier-Balloy B, Janier M, Cordoliani F, Bagot M, Rybojad M, Bouaziz JD. Neutrophilic skin lesions in autoimmune connective tissue diseases: nine cases and a literature review. Medicine (Baltimore) 2014; 93:e346. [PMID: 25546688 PMCID: PMC4602621 DOI: 10.1097/md.0000000000000346] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The pathophysiology of neutrophilic dermatoses (NDs) and autoimmune connective tissue diseases (AICTDs) is incompletely understood. The association between NDs and AICTDs is rare; recently, however, a distinctive subset of cutaneous lupus erythematosus (LE, the prototypical AICTD) with neutrophilic histological features has been proposed to be included in the spectrum of lupus. The aim of our study was to test the validity of such a classification. We conducted a monocentric retrospective study of 7028 AICTDs patients. Among these 7028 patients, a skin biopsy was performed in 932 cases with mainly neutrophilic infiltrate on histology in 9 cases. Combining our 9 cases and an exhaustive literature review, pyoderma gangrenosum, Sweet syndrome (n = 49), Sweet-like ND (n = 13), neutrophilic urticarial dermatosis (n = 6), palisaded neutrophilic granulomatous dermatitis (n = 12), and histiocytoid neutrophilic dermatitis (n = 2) were likely to occur both in AICTDs and autoinflammatory diseases. Other NDs were specifically encountered in AICTDs: bullous LE (n = 71), amicrobial pustulosis of the folds (n = 28), autoimmunity-related ND (n = 24), ND resembling erythema gyratum repens (n = 1), and neutrophilic annular erythema (n = 1). The improvement of AICTDS neutrophilic lesions under neutrophil targeting therapy suggests possible common physiopathological pathways between NDs and AICTDs.
Collapse
Affiliation(s)
- Estelle Hau
- From the Dermatology Department (EH, AS, MJ, FC, MarB, MR, JDB) and Pathology Department (MDVP, MaxB, BCB), Paris Diderot University, Sorbonne Paris Cité, AP-HP, Saint Louis Hospital, Paris, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
|
17
|
Nakazono S, Nojima K, Kumagai J, Hagiyama H, Yokozeki H, Namiki T. Amicrobial pustulosis-like rash associated with systemic lupus erythematosus. J Dermatol 2014; 41:359-60. [PMID: 24612394 DOI: 10.1111/1346-8138.12423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Sonoko Nakazono
- Department of Dermatology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | | | | | | | | | | |
Collapse
|
18
|
Marzano AV, Borghi A, Meroni PL, Crosti C, Cugno M. Immune-mediated inflammatory reactions and tumors as skin side effects of inflammatory bowel disease therapy. Autoimmunity 2014; 47:146-53. [PMID: 24437626 DOI: 10.3109/08916934.2013.873414] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
All drugs currently used for treating patients with inflammatory bowel disease (IBD - including Crohn's disease and ulcerative colitis) have the potential to induce skin lesions ranging from mild eruptions to more serious and widespread clinical presentations. The number of cutaneous adverse reactions due to IBD therapies is progressively increasing and the most frequently involved drugs are thiopurines and biologics like tumor necrosis factor (TNF)-α antagonists. The main drug-induced cutaneous manifestations are non-melanoma skin cancer (NMSC), notably basal cell and squamous cell carcinomas, and viral skin infections for thiopurines and psoriasiform, eczematoid and lichenoid eruptions as well as skin infections and cutaneous lupus erythematosus for biologics. Cutaneous manifestations should be promptly recognized and correctly diagnosed in order to quickly establish an adequate therapy. The main treatment for NMSC is surgical excision whereas the management of immune-mediated inflammatory skin reactions varies from topical therapy for mild presentations to the shift to another drug alone or in combination with corticosteroids for extensive eruptions.
Collapse
Affiliation(s)
- Angelo V Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico , Milano , Italy
| | | | | | | | | |
Collapse
|