Exacerbation of Atopic Dermatitis Associated with Ustekinumab Treatment in Crohn's Disease

Abstract

Ustekinumab inhibits interleukins 12 and 23 and modulates the T helper cell-mediated immune response of Crohn's disease. However, ustekinumab may also exacerbate atopic disease by increasing the T helper 2 cellmediated pathway. We present the first known case of exacerbation of atopic dermatitis in a patient with Crohn's disease receiving ustekinumab. Additional associations in dose frequency, peripheral eosinophilia, and elevated serum IgE were observed. However, while novel in Crohn's disease, exacerbation of atopy after ustekinumab infusion has been observed in patients with psoriasis and psoriatic arthritis.

Development of a clinical algorithm to predict phenotypic switches between atopic dermatitis and psoriasis (the “Flip‐Flop” phenomenon)

“…The inhibition of one immunological axis might thus lead to an imbalance in which the opposite immunological axis might dominate inflammation and thus resulting in FF. This has been observed for other chronic systemic Th1/Th17 and Th2 skewed diseases as well (e.g., FF from PV (Th1/Th17) to bullous pemphigoid (Th2) 70 or exacerbation of AD (Th2) in a patient with Crohn's disease (Th1) (all under biological therapy with ustekinumab) 71 . The co‐occurrence of PV and bullous pemphigoid has been frequently described as well 72 …”

“…This has been observed for other chronic systemic Th1/Th17 and Th2 skewed diseases as well (e.g., FF from PV (Th1/Th17) to bullous pemphigoid (Th2) 70 or exacerbation of AD (Th2) in a patient with Crohn's disease (Th1) (all under biological therapy with ustekinumab). 71 The co-occurrence of PV and bullous pemphigoid has been frequently described as well. 72 However, secukinumab and dupilumab belong to the first approved biologics for PV respectively AD, which could bias the frequencies of caused FF phenomena.…”