银屑病生物制剂治疗后湿疹化发生机制及应对策略

doi:10.35541/cjd.20220578

Abstract

Abstract: 【Abstract】 Eczematous dermatitis may occur in some patients with psoriasis following biological therapy. This review elucidates potential pathological mechanisms underlying this phenomenon and summarizes strategies for managing eczematization. Topical or systemic glucocorticoid treatment can effectively control some eczematous conditions; in some cases, discontinuation or switching to another types of biologic agents may be considered, especially the combination of immunosuppressants, dupilumab, or phosphodiesterase-4 inhibitors.

Key words: Psoriasis, Biological agents, Eczema, Dermatitis, atopic, Therapy, Pathogenesis

Zong Yangyongyi, Ma Chujun, Su Zhonglan. Eczematization following the treatment of psoriasis with biological agents: pathogenesis and management[J]. Chinese Journal of Dermatology,2024,e20220578. doi:10.35541/cjd.20220578

References ［47］

［1］	王宇, 杨斌. 银屑病与特应性皮炎的T细胞免疫失衡机制研究进展［J］. 皮肤性病诊疗学杂志, 2021,28（3）:232⁃236. doi：10.3969/j.issn.1674⁃8468.2021.03.019.
［2］	Caldarola G, Pirro F, Di Stefani A, et al. Clinical and histopathological characterization of eczematous eruptions occurring in course of anti IL⁃17 treatment: a case series and review of the literature［J］. Expert Opin Biol Ther, 2020,20（6）:665⁃672. doi: 10.1080/14712598.2020.1727439.
［3］	Driessen RJ, Berends MA, Boezeman JB, et al. Psoriasis treatment with etanercept and efalizumab: clinical strategies influencing treatment outcome［J］. Br J Dermatol, 2008,158（5）:1098⁃1106. doi: 10.1111/j.1365⁃2133.2008.08514.x.
［4］	Saeki H, Nakagawa H, Nakajo K, et al. Efficacy and safety of ixekizumab treatment for Japanese patients with moderate to severe plaque psoriasis, erythrodermic psoriasis and generalized pustular psoriasis: results from a 52⁃week, open⁃label, phase 3 study （UNCOVER⁃J）［J］. J Dermatol, 2017,44（4）:355⁃362. doi: 10.1111/1346⁃8138.13622.
［5］	Liakos W, Toussi A, Le ST, et al. Anti⁃interleukin 23⁃based therapies may shift cutaneous immune responses: a case of new⁃onset contact dermatitis to carbamates after guselkumab for psoriasis［J］. Dermatitis, 2021,32（6）:e113⁃e115. doi: 10.1097/DER.0000000000000765.
［6］	Martinez⁃Mera C, González MA, Hospital M, et al. Isothiazolinones in paint as a cause of airborne contact dermatitis in a patient with psoriasis receiving anti⁃interleukin⁃17 therapy［J］. Contact Dermatitis, 2019,80（5）:328⁃329. doi: 10.1111/cod.13203.
［7］	Dhonncha EN，Razali Q，Roche L，et al. Erythroderma following ustekinumab therapy for psoriasis［J］. Br J Dermatol, 2018,179（S1）:25.
［8］	Al⁃Janabi A, Foulkes AC, Mason K, et al. Phenotypic switch to eczema in patients receiving biologics for plaque psoriasis: a systematic review［J］. J Eur Acad Dermatol Venereol, 2020,34（7）:1440⁃1448. doi: 10.1111/jdv.16246.
［9］	Bennett AN, Wong M, Zain A, et al. Adalimumab⁃induced asthma［J］. Rheumatology （Oxford）, 2005,44（9）:1199⁃1200. doi: 10. 1093/rheumatology/keh676.
［10］	Chan JL, Davis⁃Reed L, Kimball AB. Counter⁃regulatory balance: atopic dermatitis in patients undergoing infliximab infusion therapy［J］. J Drugs Dermatol, 2004,3（3）:315⁃318.
［11］	Pagan⁃Leon S, Werbel T, Montanez⁃Wiscovich M. Tumor necrosis factor inhibitor⁃induced eczematous eruption: a report of two cases and review of the literature［J］. Cureus, 2021,13（5）:e15078. doi: 10.7759/cureus.15078.
［12］	Conrad C, Di Domizio J, Mylonas A, et al. TNF blockade induces a dysregulated type I interferon response without autoimmunity in paradoxical psoriasis［J］. Nat Commun, 2018,9（1）:25. doi: 10.1038/s41467⁃017⁃02466⁃4.
［13］	Psarras A, Antanaviciute A, Alase A, et al. TNF⁃α regulates human plasmacytoid dendritic cells by suppressing IFN⁃α production and enhancing T cell activation［J］. J Immunol, 2021,206（4）:785⁃796. doi: 10.4049/jimmunol.1901358.
［14］	Napolitano M, Megna M, Fabbrocini G, et al. Eczematous eruption during anti⁃interleukin 17 treatment of psoriasis: an emerging condition［J］. Br J Dermatol, 2019,181（3）:604⁃606. doi: 10.1111/bjd.17779.
［15］	Munera⁃Campos M, Ballesca F, Richarz N, et al. Paradoxical eczematous reaction to ixekizumab［J］. J Eur Acad Dermatol Venereol, 2019,33（1）:e40⁃e42. doi: 10.1111/jdv.15156.
［16］	Brembilla NC, Senra L, Boehncke WH. The IL⁃17 family of cytokines in psoriasis: IL⁃17A and beyond［J］. Front Immunol, 2018,9:1682. doi: 10.3389/fimmu.2018.01682.
［17］	Karamanakos A, Vergou T, Panopoulos S, et al. Psoriasis as an adverse reaction to biologic agents beyond anti⁃TNF⁃α therapy［J］. Eur J Dermatol, 2021,31（3）:307⁃317. doi: 10.1684/ejd. 2021.4056.
［18］	Murphy MJ, Cohen JM, Vesely MD, et al. Paradoxical eruptions to targeted therapies in dermatology: a systematic review and analysis［J］. J Am Acad Dermatol, 2022,86（5）:1080⁃1091. doi: 10.1016/j.jaad.2020.12.010.
［19］	Weidinger S, Willis⁃Owen SA, Kamatani Y, et al. A genome⁃wide association study of atopic dermatitis identifies loci with overlapping effects on asthma and psoriasis［J］. Hum Mol Genet, 2013,22（23）:4841⁃4856. doi: 10.1093/hmg/ddt317.
［20］	Mendes Roncada EV, Brambilla VR, Freitas Filitto B, et al. Atopic dermatitis as a paradoxical effect of secukinumab for the treatment of psoriasis［J］. Case Rep Dermatol, 2021,13（2）:336⁃339. doi: 10.1159/000513467.
［21］	Abe F, Mitsuyama S, Nagao E, et al. Atopic dermatitis⁃like eruption induced by two different biologics in a patient with psoriatic arthritis［J］. Acta Derm Venereol, 2019,99（13）:1291⁃1292. doi: 10.2340/00015555⁃3321.
［22］	Bose R, Beecker J. Dyshidrotic eczema in two patients on secukinumab for plaque psoriasis: a case report［J］. SAGE Open Med Case Rep, 2020,8:2050313X20904561. doi: 10.1177/2050313X20904561.
［23］	Arevalo M, Fonseca E, Nespereira M, et al. Eczema⁃like reactions induced by tumor necrosis factor⁃α antagonist agents［J］. J Am Acad Dermatol, 2013,68（4, Supplement 1）: AB180. doi: 10.1016/j.jaad.2012.12.743
［24］	Dumont⁃Berset M, Laffitte E, Gerber C, et al. Eczematous drug eruption after infliximab［J］. Br J Dermatol, 2004,151（6）:1272⁃1273. doi: 10.1111/j.1365⁃2133.2004.06282.x.
［25］	Reyn B, Hillary T, Gils A. Eczematous eruption after guselkumab treatment for psoriasis［J］. JAAD Case Rep, 2019,5（11）:973⁃975. doi: 10.1016/j.jdcr.2019.09.005.
［26］	Napolitano M, Gallo L, Patruno C, et al. Eczematous reaction to ixekizumab successfully treated with dupilumab［J］. Dermatol Ther, 2020,33（2）:e13218. doi: 10.1111/dth.13218.
［27］	Koschitzky M, Tan K, Noliza Encarnacion MR, et al. Eczematous reactions to psoriasis biologics treated with dupilumab: a case series［J］. JAAD Case Rep, 2021,11:29⁃32. doi: 10.1016/j.jdcr. 2021.03.006.
［28］	Chicharro P, Rodríguez⁃Jiménez P, De la Fuente H, et al. Mixed profile of cytokines in paradoxical eczematous eruptions associated with anti⁃IL⁃17 therapy［J］. J Allergy Clin Immunol Pract, 2020,8（10）:3619⁃3621.e1. doi: 10.1016/j.jaip.2020.06.064.
［29］	Lai F, Higgins E, Smith CH, et al. Morphologic switch from psoriasiform to eczematous dermatitis after anti⁃IL⁃17 therapy: a case series［J］. JAMA Dermatol, 2019,155（9）:1082⁃1084. doi: 10.1001/jamadermatol.2019.1268.
［30］	Peera M, Smith A. Palmoplantar pompholyx secondary to interleukin 17A inhibitor therapy for psoriasis: a case series［J］. JAAD Case Rep, 2021,13:46⁃48. doi: 10.1016/j.jdcr.2021.03. 052.
［31］	Lai F, Pink A, Higgins E, et al. Phenotypic switch from psoriasis to eczema on anti⁃interleukin⁃17 therapy: a case series［J］. Br J Dermatol, 2019,181（S1）:42⁃43. doi: 10.1111/bjd.17752
［32］	Eichhoff G. Secukinumab⁃induced pompholyx in a psoriasis patient［J］. Dermatol Online J, 2020,26（4）:13030/qt3669k149.
［33］	Kemény L, Varga E, Novak Z. Advances in phototherapy for psoriasis and atopic dermatitis［J］. Expert Rev Clin Immunol, 2019,15（11）:1205⁃1214. doi: 10.1080/1744666X.2020.1672537.
［34］	Damiani G, Pacifico A, Chu S, et al. Frequency of phototherapy for treating psoriasis: a systematic review［J］. Ital J Dermatol Venerol, 2022,157（3）:215⁃219. doi: 10.23736/S2784⁃8671.21. 06975⁃3.
［35］	Eyerich S, Onken AT, Weidinger S, et al. Mutual antagonism of T cells causing psoriasis and atopic eczema［J］. N Engl J Med, 2011,365（3）:231⁃238. doi: 10.1056/NEJMoa1104200.
［36］	Ono S, Honda T, Doi H, et al. Concurrence of psoriasis vulgaris and atopic eczema in a single patient exhibiting different expression patterns of psoriatic autoantigens in the lesional skin［J］. JAAD Case Rep, 2018,4（5）:429⁃433. doi: 10.1016/j.jdcr. 2017.11.026.
［37］	Park JW, Park SJ, Koh YG, et al. Dupilumab⁃induced palmoplantar psoriasis: is it true psoriasis?［J］. Dermatitis, 2022,33（3）:e33⁃e35. doi: 10.1097/DER.0000000000000824.
［38］	Mirza FN, Wang A, Ramachandran SM, et al. Dupilumab⁃induced phenotype switch from atopic dermatitis to psoriasis is characterized by de novo interleukin⁃17A expression: a case report［J］. Br J Dermatol, 2021,185（2）:432⁃434. doi: 10.1111/bjd.20064.
［39］	Beaziz J, Bouaziz JD, Jachiet M, et al. Dupilumab⁃induced psoriasis and alopecia areata: case report and review of the literature［J］. Ann Dermatol Venereol, 2021,148（3）:198⁃201. doi: 10.1016/j.annder.2021.02.003.
［40］	Imafuku S, Maeyama A. Remission of anti⁃tumor necrosis factor⁃α antibody⁃induced palmoplantar pustulosis with the Janus kinase inhibitor baricitinib in a patient with rheumatoid arthritis［J］. J Dermatol, 2021,48（5）:e240⁃e241. doi: 10.1111/1346⁃8138.15860.
［41］	Wang YA, Rosenbach M. Successful treatment of refractory tumor necrosis factor inhibitor⁃induced palmoplantar pustulosis with tofacitinib: report of case［J］. JAAD Case Rep, 2020,6（2）:115⁃118. doi: 10.1016/j.jdcr.2019.12.006.
［42］	Licata G, Gambardella A, Tancredi V, et al. Face atopic dermatitis resistant to dupilumab: a case series of three patients successfully treated with upadacitinib［J］. J Eur Acad Dermatol Venereol, 2022,36（2）:e150⁃e152. doi: 10.1111/jdv.17705.
［43］	Rodrigues MA, Torres T. JAK/STAT inhibitors for the treatment of atopic dermatitis［J］. J Dermatolog Treat, 2020,31（1）:33⁃40. doi: 10.1080/09546634.2019.1577549.
［44］	Kvist⁃Hansen A, Hansen PR, Skov L. Systemic treatment of psoriasis with JAK inhibitors: a review［J］. Dermatol Ther （Heidelb）, 2020,10（1）:29⁃42. doi: 10.1007/s13555⁃019⁃00347⁃w.
［45］	Mease PJ, Lertratanakul A, Papp KA, et al. Upadacitinib in patients with psoriatic arthritis and inadequate response to biologics: 56⁃week data from the randomized controlled phase 3 SELECT⁃PsA 2 study［J］. Rheumatol Ther, 2021,8（2）:903⁃919. doi: 10.1007/s40744⁃021⁃00305⁃z.
［46］	Hayakawa M, Izumi K, Higashida⁃Konishi M, et al. Tocilizumab⁃induced psoriasis⁃like eruption resolved by shortening the dose interval in a patient with rheumatoid arthritis: a case⁃based review［J］. Rheumatol Int, 2019,39（1）:161⁃166. doi: 10.1007/s00296⁃018⁃4175⁃1.
［47］	Cacabelos R, Naidoo V, Corzo L, et al. Genophenotypic factors and pharmacogenomics in adverse drug reactions［J］. Int J Mol Sci, 2021,22（24）:13302. doi: 10.3390/ijms222413302.

[1]	Chen Yanyan, Zhang Hanlin, Liu Liping, Li Yumei. Correlations between circadian rhythm and melanoma [J]. Chinese Journal of Dermatology, 2026, 59(1): 82-85.
[2]	Xue Tianping, Lu Zhenzhong, Wang Hongsheng. Relationship between the pathogenesis of psoriasis and microbial flora [J]. Chinese Journal of Dermatology, 2026, 59(1): 89-92.
[3]	Jiang Jiayi, Wang Daguang. Prevention and management of thrombus during the perioperative period in dermatologic surgery [J]. Chinese Journal of Dermatology, 2026, 59(1): 85-88.
[4]	Writing committee of “Chinese expert consensus on the diagnosis and treatment of scabies （ edition）”. Chinese expert consensus on the diagnosis and treatment of scabies （2026 edition） [J]. Chinese Journal of Dermatology, 2026, 59(1): 1-8.
[5]	Xiang Leihong, Xu Zhongyi . Diagnosis and treatment of acquired dermal macular hyperpigmentation: challenges and strategies [J]. Chinese Journal of Dermatology, 2026, 59(1): 74-76.
[6]	Chinese Society of Dermatology, China Dermatologist Association, Combination of Traditional and Western Medicine Dermatology, Chinese Non-Government Dermatologist Institutions Association. Expert consensus on educational guidance for rosacea patients（2025） [J]. Chinese Journal of Dermatology, 2026, 0(1): 20240725-e20240725.
[7]	Yao Wo, Wang Huiying. Lanadelumab in the treatment of hereditary angioedema: a systematic review of clinical trials [J]. Chinese Journal of Dermatology, 2026, 59(1): 77-81.
[8]	Dai Yeqin, Song Xiuzu. Application of hair follicle transplantation and follicular cell suspension transplantation in the treatment of vitiligo [J]. Chinese Journal of Dermatology, 2025, 58(9): 882-885.
[9]	Xu Zhongyi, Xing Xiaoxue, Dong Yaqi, Zhang Chengfeng, Xiang Leihong. Retrospective analysis of clinical manifestations and treatment outcomes in 254 patients with melasma in a tertiary grade-A hospital in Shanghai [J]. Chinese Journal of Dermatology, 2025, 58(9): 808-815.
[10]	He Muyang, Jin Shanglin, Zhang Chengfeng. Roles of sex hormones and underlying mechanisms in the pathogenesis of melasma [J]. Chinese Journal of Dermatology, 2025, 58(9): 863-867.
[11]	Jiang Ziqi, Zhong Judan, Chen Tingqiao, Chen Jin. Pathogenesis and treatment of melasma [J]. Chinese Journal of Dermatology, 2025, 58(9): 868-872.
[12]	Zhong Jiemin, Li Wei, Zhang Shujuan, Yang Yan, Xue Rujun, Li Xinyi, Ke Yanan, Chen Xiaoyin, Chen Quan. Comparison of the efficacy and safety of nanomicroneedle- versus ultrasound-mediated delivery of tranexamic acid for the treatment of melasma: a randomized controlled study [J]. Chinese Journal of Dermatology, 2025, 58(9): 829-833.
[13]	Guliziba·Tuersun, Zhao Yanan, Wang Hongjuan, Kang Xiaojing, Qu Yuanyuan. Efficacy of autologous melanocyte transplantation combined with 308-nm light-emitting diode phototherapy at escalating doses in the treatment of refractory stable vitiligo: a clinical observation [J]. Chinese Journal of Dermatology, 2025, 58(9): 852-856.
[14]	Zhou Miaoni, Sheng Anqi, Fu Lifang, Jin Rong, Xu Wen, Wei Xiaodong, Xu Ai′e . Efficacy and safety of an antioxidant gel containing tea polyphenols combined with narrow-band ultraviolet B in the treatment of vitiligo: a single-center randomized controlled trial [J]. Chinese Journal of Dermatology, 2025, 58(9): 834-838.
[15]	Tian Cuicui, Chen Hao. Pathogenesis of cutaneous T-cell lymphoma-related pruritus [J]. Chinese Journal of Dermatology, 2025, 58(9): 890-892.

Eczematization following the treatment of psoriasis with biological agents: pathogenesis and management

PDF

PDF (Mobile)

Knowledge

Abstract

Cite this article

share this article

References ［47］

Related Articles 15

Metrics

Comments

Recommended 10