Development of bullous pemphigoid during treatment of psoriatic onycho‐pachydermo periostitis with ustekinumab

Abstract

Ustekinumab is a human monoclonal antibody that specifically binds to the p40 subunit of interleukin (IL)-12 and IL-23, inhibiting the activity of both cytokines, thereby blocking the T-helper (Th)1 and Th17 inflammatory pathways. While biologic agents have dramatically changed the strategies of psoriasis treatment, increasing cases of autoimmune diseases during the use of such agents have been reported. We experienced a case of bullous pemphigoid occurring during treatment of a rare variant of psoriatic arthritis, psoriatic onycho-pachydermo periostitis with ustekinumab. Only six cases of autoimmune blistering diseases during treatment with biologic agents have ever been reported including our case, and we herein review the published work of these cases. Dermatologists must be attentive to the possibility of autoimmune blistering diseases during ustekinumab treatment.

Psoriasis is associated with increased risk of bullous pemphigoid: A nationwide population‐based cohort study in Taiwan

“…4,11 Despite their relative safety, autoimmune processes mediated by biologic agents such as tumor necrosis factor-a inhibitors, ustekinumab and secukinumab, have been reported to lead to BP development. 4,17,18 In our study, among psoriatic patients with BP under 60 years of age, 37.5% of cases had a history of immunosuppressant use, which is significantly higher than that noticed among patients aged 60 years or older. We speculate that inflammatory effects in patients with moderate to severe psoriasis who have used immunosuppressants in earlier life may increase the occurrence of BP due to alteration of the antigenicity of the basement membrane and the consequent autoantibody formation.…”

“…On the other hand, immunosuppressants, such as biologic agents, were commonly used in patients with moderate to severe psoriatic patients . Despite their relative safety, autoimmune processes mediated by biologic agents such as tumor necrosis factor‐α inhibitors, ustekinumab and secukinumab, have been reported to lead to BP development . In our study, among psoriatic patients with BP under 60 years of age, 37.5% of cases had a history of immunosuppressant use, which is significantly higher than that noticed among patients aged 60 years or older.…”

Development of bullous pemphigoid during secukinumab treatment for psoriasis

“…Despite the relative safety, there are reported autoimmune processes after use of these agents, including BP after TNF-a inhibitors and ustekinumab. 1,2 Duration of the biological agents before the onset of BP varied from 1 week to 38 months. 2 Pathogenic hypotheses included the altered balance between T helper (Th)1/Th2 response, loss of autoreactive B-cell suppression, and susceptibility to minor infections.…”

“…1,2 Duration of the biological agents before the onset of BP varied from 1 week to 38 months. 2 Pathogenic hypotheses included the altered balance between T helper (Th)1/Th2 response, loss of autoreactive B-cell suppression, and susceptibility to minor infections. 1,2 The present patient represents the first case of BP possibly triggered by secukinumab.…”

“…2 Pathogenic hypotheses included the altered balance between T helper (Th)1/Th2 response, loss of autoreactive B-cell suppression, and susceptibility to minor infections. 1,2 The present patient represents the first case of BP possibly triggered by secukinumab. The occurrence of BP during secukinumab seems paradoxical, as increasing evidence supports the role of Th17 cells in the pathogenesis of BP, and drugs targeting IL-17 have been under clinical trials with results pending.…”