生物制剂治疗银屑病诱发湿疹样皮肤不良反应8例分析

Analysis of 8 cases of acute eczematous skin adverse reactions induced by psoriasis treated with biological agents

目的分析生物制剂治疗银屑病诱发湿疹样皮肤不良反应的临床特点,为临床提供参考。方法收集北京京城皮肤医院在2021年4月~2023年4月间应用生物制剂治疗银屑病发生湿疹样皮肤不良反应的8例患者,回顾性分析病史、发病过程、皮疹表现、治疗转归和实验室检查等。结果8例患者均有过敏性疾病个人史和家族史;诱发皮肤不良反应的生物制剂包括:依奇珠单抗2例次,司库奇尤单抗8例次,古塞奇尤单抗3例次;诱导时间最短3d,最长56周;8例患者均以急性湿疹样皮损为主要表现;不良反应发生后停用生物制剂,1例次给予糖皮质激素、3例次给予环孢素、2例次给予复方甘草酸苷、1例次给予乌帕替尼、5例次给予阿布昔替尼等治疗后皮疹消退;所有8例患者外周血嗜酸粒细胞百分比和免疫球蛋白E(IgE)在不良反应发生后较反应前均有较明显的升高。结论特应性体质是银屑病患者生物制剂发生皮肤不良反应的危险因素,应慎重选择生物制剂治疗;不同治疗靶点的生物制剂均可能诱发皮肤不良反应;回归和保持免疫平衡可作为治疗策略;阿布昔替尼等Janus激酶(JAK)抑制剂可能成为治疗的新选择。

Objective To analyze the clinical characteristics of acute eczematous skin adverse reactions induced by psoriasis treated with biological agents,and provide reference for clinical practice.Methods Eight patients with acute eczematous skin adverse reactions to psoriasis treated with biological agents at Beijing Jingcheng Skin Hospital from April 2021 to April 2023 were collected.The medical history,pathogenic process,rash manifestations,treatment outcomes,and laboratory tests were analyzed.Results All 8 cases had personal and family history of allergic diseases.The biological agents that induce skin adverse reactions include:2 cases of ixekizumab,8 cases of secukinumab,and 3 cases of guselkumab;The shortest induction time was 3 days and the longest was 56 weeks;All 8 cases showed acute eczematous dermatitis as the main manifestation.After discontinuation of biologics,1 administration of glucocorticoids,3 of cyclosporine,2 of Compound Glycyrrhizin,1 of upatinib,and 5 of abrocitinib,the rash subsided after treatment.All 8 patients showed a significant increase in the percentage of eosinophils and immunoglobulin E(IgE)in peripheral blood after the occurrence of adverse reactions compared to before.Conclusion Atopic constitution is a risk factor for skin adverse reactions caused by biological agents in psoriasis patients,so biological agents should be carefully selected.Biological agents with different therapeutic targets may induce skin adverse reactions.Returning to and maintaining immune balance can serve as therapeutic strategies.Janus kinase inhibitors such as abrocitinib may become a new treatment option.