常用皮肤科生物制剂治疗中的矛盾性反应及机制

Paradoxical Reactions and Mechanisms in the Treatment of Biological Agents Commonly Used in Dermatology

生物制剂已广泛应用于皮肤慢性炎症性疾病,如银屑病、特应性皮炎等疾病的临床治疗中,但是治疗过程中皮肤和其他器官会出现非感染性的新发炎症或原发部位炎症加剧等不良现象,即矛盾性反应。引起的矛盾性反应表现从矛盾性银屑病、矛盾性湿疹、矛盾性化脓性汗腺炎到狼疮样反应不等,在临床上前两种矛盾性反应最为常见。本文拟对目前皮肤科常用生物制剂治疗中的矛盾性反应、潜在发生机制及应对策略进行回顾与总结,为提高临床医生对矛盾性反应的认识,为今后更合理应用生物制剂、规范处理矛盾性反应提供依据。

Biologic agents have been widely used in the treatment of chronic inflammatory skin diseases,such as psoriasis,atopic dermatitis and others.However,during the treatment process,non⁃infectious new inflammation or increased inflammation at the primary site may occur in the skin and other organs,which are paradoxical reactions.Paradoxical reactions include paradoxical psoriasis,paradoxical eczema,paradoxical hidradenitis suppurativa,lupus⁃like reactions and others.The first two paradoxical reactions are the most common in clinical practice.We review and summarize the paradoxical reactions,potential mechanisms and management strategies in the treatment of commonly used biologic agents in dermatology to provide a basis for clinicians to use biologic agents more rationally and standardize the management of induced paradoxical reactions.