A case of generalized guttate psoriasis induced by etanercept with relapse after abatacept

Brigant, F.; Clavel, Gaëlle; Chatelain, Denis; Lok, C.; Chaby, Guillaume

doi:10.5070/d38m24603s

Cited by 13 publications

(2 citation statements)

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“…physical or chemical injury to the skin), 83,84 medications (e.g. dupilumab, certolizumab, efalizumab, brentuximab vedotin, imatinib, IFNα2b, propranolol, digoxin, clonidine, quinidine, chloroquine, hydroxychloroquine, lithium, cimetidine, carbamazepine, fluoxetine, olanzapine and 3,4-methylenedioxy-methamphetamine also known as ecstasy), [85][86][87][88][89][90][91][92][93][94][95][96][97][98][99][100] family or personal history of psoriasis [101][102][103] and stressful life events 9,84 are suggested as triggering factors. 6 In a study of 1017 patients with psoriasis, 663 (65.2%) patients had onset of psoriasis before 40 years of age and 354 (34.8%) had onset on or after 40 years of age.…”

Section: Aetiopathogenesismentioning

confidence: 99%

Childhood guttate psoriasis: an updated review

Leung,

Barankin,

Lam

et al. 2023

DIC

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Background Guttate psoriasis is common and affects 0.5–2% of individuals in the paediatric age group. This review aims to familiarize physicians with the clinical manifestations, evaluation, diagnosis and proper management of guttate psoriasis. Methods A search was conducted in July 2023 in PubMed Clinical Queries using the key term “guttate psoriasis”. The search strategy included all observational studies, clinical trials and reviews published within the past 10 years. The information retrieved from the search was used in the compilation of the present article. Results Guttate psoriasis typically presents with an abrupt onset of numerous, small, scattered, tear-drop-shaped, scaly, erythematous, pruritic papules and plaques. Sites of predilection include the trunk and proximal extremities. There may be a history of preceding streptococcal infection. Koebner phenomenon is characteristic. Guttate psoriasis may spontaneously remit within 3–4 months with no residual scarring, may intermittently recur and, in 40–50% of cases, may persist and progress to chronic plaque psoriasis. Given the possibility for spontaneous remission within several months, active treatment may not be necessary except for cosmetic purposes or because of pruritus. On the other hand, given the high rates of persistence of guttate psoriasis and progression to chronic plaque psoriasis, some authors suggest active treatment of this condition. Conclusion Various treatment options are available for guttate psoriasis. Triggering and exacerbating factors should be avoided if possible. Topical corticosteroids alone or in combination with other topical agents (e.g. tazarotene and vitamin D analogues) are the most rapid and efficient treatment for guttate psoriasis and are therefore the first-line treatment for mild cases. Other topical therapies include vitamin D analogues, calcineurin inhibitors, anthralin, coal tar and tazarotene. Ultraviolet phototherapy is the first-line therapy for moderate-to-severe guttate psoriasis, as it is more practical than topical therapy when treating widespread or numerous small lesions. Systemic immunosuppressive and immunomodulatory therapies (e.g. methotrexate, cyclosporine, retinoids, fumaric acid esters and biologics) may be considered for patients with moderate-to-severe guttate psoriasis who fail to respond to phototherapy and topical therapies.

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Section: Aetiopathogenesismentioning

confidence: 99%

Childhood guttate psoriasis: an updated review

Leung,

Barankin,

Lam

et al. 2023

DIC

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“…[20] Subsequently, other reports sporadically reported the development or recrudescence of skin psoriasis during treatment with abatacept. [21][22][23][24][25][26][27] Psoriatic skin lesions are well-known cutaneous adverse events of anti-TNF-α antagonists. [28] The pathogenesis of this phenomenon appears to involve a disruption in cytokine balance following TNF-α inhibition, resulting in the up-regulation of plasmacytoid dendritic cells and the subsequent production of unopposed interferon-α, following a triggering event in predisposed individuals.…”

Section: Safety Profilementioning

confidence: 99%

Abatacept in psoriatic arthritis: Case report and short review

Ursini

Naty

Russo

et al. 2013

Journal of Pharmacology and Pharmacotherapeutics

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Psoriatic arthritis (PsA) is a chronic inflammatory disease affecting about 6-10% of patients with cutaneous psoriasis. According to current knowledge, activated T-cells seem to play a pivotal role in the pathogenesis of both psoriasis and PsA. Abatacept is a novel biologic agent selectively designed to interfere with T-cells co-stimulation. Structurally, it is a soluble, fully human fusion protein consisting of the extracellular domain of CTLA-4 (Cytotoxic T-Lymphocyte Antigen 4) linked to a modified Fc portion of human IgG1. Abatacept is now approved as a first-line treatment for rheumatoid arthritis (RA), but preliminary data disclose a potential role of abatacept in the treatment of other autoimmune diseases. In this article, we report a case of successful treatment with abatacept of a psoriatic arthritis patients who developed adverse drug reactions (ADRs) to medication commonly used in PsA, including three different anti-TNF-α agents. In addition, we review the scientific evidences supporting a possible role of abatacept in treatment of patients with psoriasis and PsA and the paradox of abatacept-induced psoriasis.

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