度普利尤单抗诱导的银屑病样反应研究进展

Research progress of the dupilumab-induced psoriasiform reaction

近年来度普利尤单抗广泛用于治疗中、重度特应性皮炎,且取得了显著的疗效,但同时也出现了一种不容忽视的、临床实验中未记录的不良反应,即其可诱发部分患者出现银屑病样皮损,称之为度普利尤单抗诱导的银屑病样反应。其组织病理表现以典型的银屑病样改变为主,部分可存在轻微的海绵样变。潜在的发病机制可能与免疫漂移、抗菌肽的作用、中性粒细胞的作用或遗传易感性有关。该文对度普利尤单抗诱导的银屑病的临床表现、组织病理学特征及其可能的发病机制做一阐述,为识别和治疗度普利尤单抗诱导的银屑病提供依据。

Dupilumab is a humanized IgG4 monoclonal antibody that targets the IL-4 receptor alpha chain,which has been widely used in moderate-to-severe atopic dermatitis in uncontrolled patients in recent years and has proven to be effective.However,there is an adverse reaction which is noteworthy and unrecorded in phase Ⅲ study.It has been found that dupilumab can induce psoriasiform eruption in some patients.The histologic characterization of most patients shows a typical psoriasiform reaction pattern,and sometimes minimal spongiosis can be observed.The pathogenesis of this reaction could be related to type 1 helper T cells/type 2 helper T cells immune drift,the function of antibacterial peptides and neutrophils,or genetic predisposition.Therefore,this review elaborates on the clinical manifestation,histopathologic features and possible pathogenesis of dupilumab-induced psoriasiform reaction,aiming to provide evidence for the identification and treatment of dupilumab-induced psoriasiform reaction..