Dupilumab-Induced Palmoplantar Psoriasis: Is It True Psoriasis?

Park, Jae Wan; Park, Su Jung; Koh, Young Gue; Park, Kui Young; Seo, Seong Jun

doi:10.1097/der.0000000000000824

Cited by 6 publications

(5 citation statements)

References 5 publications

(9 reference statements)

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“…Additionally, trunk (37.1%) and scalp (31.4%) were other common locations in adults, while pediatric psoriasis was more common on the face and neck (55.6%). Palmoplantar and nail psoriasis have also been reported, occurring alone or in combination with lesions elsewhere [9, 20, 25, 28]. Recently, Fan et al [30] reported a case of reverse psoriasis occurring in the armpits, indicating that flexural and intertriginous areas could also be affected by DAPs/PsM, especially easy to be confused with preexisting AD.…”

Section: Clinical Manifestations Of Daps/psmmentioning

confidence: 99%

“…Topical glucocorticoids (84.4%) or combinations of glucocorticoids and vitamin D derivatives (18.8%) were widely applied to these patients, consistent with the preferred conventional treatments of mild classic psoriasis. Phototherapy (narrow-band UVB) [12, 14] and systemic therapies (oral steroids [12, 21, 26, 34], cyclosporine [21, 28, 32], and mycophenolate mofetil [23]) were also reported for the treatment of mild-to-moderate DAPs/PsM. Most patients’ psoriasiform lesions could be completely cleared or partly improved after sufficient topical therapies.…”

Section: Management and Prevention Of Daps/psmmentioning

confidence: 99%

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Dupilumab-Associated Psoriasis and Psoriasiform Manifestations: A Scoping Review

Zheng¹

2023

Dermatology

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Background: Dupilumab is the first approved IL-4Rα inhibitor for the treatment of atopic dermatitis (AD) at present with good efficacy and safety. However, there have been several reports of psoriasis and psoriasiform manifestations occurring after dupilumab therapy in recent years, showing a new paradoxical cutaneous reaction associated with biologics. Summary: This is a scoping review in order to summarize the demographics and epidemiology, clinical manifestations, diagnosis, potential pathogenesis, and promising management of dupilumab-associated psoriasis and psoriasiform manifestations (DAPs/PsM). Key Message: The present review suggests that DAPs/PsM may occur in approximately 1.8-3.3% of AD patients after dupilumab therapy. In general, DAPs/PsM manifests similar clinical and histological features to classic psoriasis but not identical. T-cell polarization skewing between Th17 and Th2 spectrum may act as the core mechanism of DAPs/PsM, characterized by up-regulated IL-23/Th17 axis. Mild-to-moderate DAPs/PsM responds well to topical therapies while discontinuation of dupilumab is recommended in severe cases. Currently, JAK inhibitors and the combination of dupilumab with other biologics are considered as potential treatments for concurrent AD and psoriasis. Future researches are needed to clarify the detailed mechanism of this phenomenon in order to seek more effective management and prevention.

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Section: Clinical Manifestations Of Daps/psmmentioning

confidence: 99%

Section: Management and Prevention Of Daps/psmmentioning

confidence: 99%

Dupilumab-Associated Psoriasis and Psoriasiform Manifestations: A Scoping Review

Zheng¹

2023

Dermatology

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“…17 Vice-versa, there are case reports on new-onset psoriasis during anti-IL4/IL-13 receptor therapy. 18,19 Apart from differently polarized T-cell immune responses, there F I G U R E 3 Schematic diagram comparing the pathogenesis of plaque type psoriasis and eczematized psoriasis. Mechanic injury, cell stress, and autoantigens initiate a Th17-dominant immune response in plaque psoriasis.…”

Section: Pathogenesis Differential Pathogenesis Of Psoriasis and Admentioning

confidence: 99%

“…In fact, recombinant IL‐4 has been suggested as a therapeutic for psoriasis, although approval has never been achieved 17 . Vice‐versa, there are case reports on new‐onset psoriasis during anti‐IL4/IL‐13 receptor therapy 18,19 . Apart from differently polarized T‐cell immune responses, there are also other mediators, such as IL‐17C or IL‐17E and keratinocyte‐derived cytokines, which have been described in the context of both type 2 and type 3 inflammatory skin diseases.…”

Section: Pathogenesismentioning

confidence: 99%

Eczematized psoriasis – a frequent but often neglected variant of plaque psoriasis

Lauffer

Eyerich

2023

J Deutsche Derma Gesell

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Summary Psoriasis is a common chronic inflammatory skin disease that causes systemic inflammation and severely impacts the patient's quality of life. Several highly effective therapeutics for psoriasis have been approved in recent years. However, in real life, a high proportion of patients either do not experience the clinical improvement observed in clinical trials or develop a secondary loss of efficacy. This may be a result of unrecognized endotypes of psoriasis that need to be characterized in greater depth to enable selection of an appropriate therapy. Eczematized psoriasis, which occurs in approximately 5–10% of patients with psoriasis, is an often‐neglected variant of psoriasis. The term “eczematized psoriasis” refers to patients developing psoriasis with similarities to eczema. These patients typically present with severe itching, and skin biopsies often reveal eosinophil granulocytes, serum crusts, or spongiosis, which are frequently observed in eczema. From an immunological perspective, additional signaling pathways that are responsible for eczema reactions might be activated in eczematized psoriasis compared to classical plaque psoriasis. This review summarizes the key clinical, histological, and immunological features of eczematized psoriasis, proposes diagnostic criteria, and evaluates the therapeutic options for eczematized psoriasis.

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“…Tatsächlich wurde rekombinantes IL‐4 erfolgreich als Therapeutikum für die Psoriasis getestet, obwohl es nie zu einer Zulassung kam 17 . Umgekehrt gibt es Fallberichte über eine neu auftretende Psoriasis während einer Anti‐IL4/IL‐13‐Rezeptor‐Therapie mit Dupilumab 18,19 . Neben den unterschiedlich polarisierten T‐Zell‐Immunantworten gibt es auch andere Mediatoren wie IL‐17C oder IL‐17E, die sowohl im Zusammenhang mit entzündlichen Hauterkrankungen vom Typ 2 als auch vom Typ 3 beschrieben wurden.…”

Section: Pathogeneseunclassified

Ekzematisierte Psoriasis – eine häufige, aber oft vernachlässigte Variante der Plaque‐Psoriasis

Lauffer

Eyerich

2023

J Deutsche Derma Gesell

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ZusammenfassungPsoriasis ist eine der häufigsten chronisch‐entzündlichen Hauterkrankung, die mit systemischen Entzündungsreaktionen einhergeht und die Lebensqualität betroffener Patienten stark beeinträchtigt. In den letzten Jahren wurden mehrere hochwirksame Therapeutika für die Psoriasis zugelassen. In der Praxis kommt es jedoch bei einem hohen Anteil der Patienten nicht zu der in klinischen Studien beobachteten klinischen Verbesserung oder es kommt zu einem sekundären Wirkungsverlust. Dies kann möglicherweise auf bisher nicht erkannte Endotypen der Psoriasis zurückgeführt werden, die für die Wahl einer geeigneten Therapie eingehender charakterisiert werden müssen. Die ekzematisierte Psoriasis, die bei etwa 5–10% der Patienten mit Psoriasis auftritt, ist eine häufig vernachlässigte Variante der Psoriasis. Der Begriff „ekzematisierte Psoriasis“ bezieht sich auf Patienten, die unter einer Psoriasis leiden, die gewisse Ähnlichkeiten mit einem Ekzem aufweist. Betroffene Patienten haben oft einen starken Juckreiz und in Hautbiopsien lassen sich häufig eosinophile Granulozyten, Serumkrusten oder Spongiose nachweisen. Aus immunologischer Sicht werden bei der ekzematisierten Psoriasis möglicherweise zusätzliche Signalwege aktiviert, die für Ekzemreaktionen verantwortlich sind. Diese Übersichtsarbeit fasst die wichtigsten klinischen, histologischen und immunologischen Merkmale der ekzematisierten Psoriasis zusammen, schlägt diagnostische Kriterien vor und bewertet die aktuellen therapeutischen Optionen für die ekzematisierte Psoriasis.

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Dupilumab-Induced Palmoplantar Psoriasis: Is It True Psoriasis?

Cited by 6 publications

References 5 publications

Dupilumab-Associated Psoriasis and Psoriasiform Manifestations: A Scoping Review

Dupilumab-Associated Psoriasis and Psoriasiform Manifestations: A Scoping Review

Eczematized psoriasis – a frequent but often neglected variant of plaque psoriasis

Ekzematisierte Psoriasis – eine häufige, aber oft vernachlässigte Variante der Plaque‐Psoriasis

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