Intralesional biologics for inflammatory dermatoses: A systematic review

Abstract

Biologic medications are systemic therapeutic options for inflammatory dermatoses. Local forms of administration are less well‐studied. To provide a summary of intralesional (IL) administration of biologics for various non‐malignant inflammatory dermatologic conditions reported in the literature. A systematic review was performed in the PubMed and Embase databases from 2000 to 2020. Inclusion criteria included the local use of biologic medications for non‐malignant cutaneous conditions. Quality was assessed with the modified Oxford Centre for Evidence‐Based Medicine ratings. A total of 19 articles describing the use of 5 biologic medications in 9 dermatologic conditions were identified, comprising 172 patients. Conditions successfully treated with intralesional biologics included pemphigus vulgaris (rituximab), granuloma faciale (rituximab), perianal Crohn's disease (infliximab), lichen sclerosus (adalimumab), and necrobiosis lipoidica (etanercept and infliximab). Intralesional etanercept reduced pruritus associated with keloids. A case report of the use of infliximab for pyoderma gangrenosum did not demonstrate any efficacy. There was no consistent effect noted with treatments for sarcoidosis (infliximab) or cutaneous lymphoid hyperplasia (rituximab). Local administration of biologic medications may offer an additional method of treating refractory inflammatory dermatoses, but further study is needed to develop standardized dosing protocols, clarify efficacy rates, and identify optimal treatment candidates.

Successful treatment of classic pyoderma gangrenosum with intralesional infliximab injection: A case report

“…Biologic agents have recently presented as a valuable option for patients with severe inflammatory skin conditions with intralesional route considered in pemphigus vulgaris (rituximab), granuloma faciale (rituximab), perianal Crohn's disease (infliximab), lichen sclerosus (adalimumab) and necrobiosis lipoidica (etanercept and infliximab) 6 …”

“…3 Biologic agents have recently presented as a valuable option for patients with severe inflammatory skin conditions with intralesional route considered in pemphigus vulgaris (rituximab), granuloma faciale (rituximab), perianal Crohn's disease (infliximab), lichen sclerosus (adalimumab) and necrobiosis lipoidica (etanercept and infliximab). 6 Studies focusing on the use of intralesional or topical biologics in PG patients are scarce. Nonetheless, such treatments may be promising as high TNF concentrations have been detected in wound fluid 7 and topical infliximab gel has successfully been used in treating chronic venous leg ulcers.…”

Intralesional Certolizumab for Refractory Lupus Pernio

“…Intralesional TNF-α blockade has previously been successfully used to treat several disease states, including an isolated arm lesion of cutaneous sarcoidosis (infliximab), necrobiosis lipoidica (etanercept/infliximab), pyoderma gangrenosum (infliximab), perianal Crohn disease (infliximab/adalimumab), balanitis xerotica obliterans (adalimumab), penile lichen sclerosis (adalimumab), and keloids (etanercept) . While studies suggest that local TNF-α inhibition is beneficial for certain granulomatous and inflammatory conditions, evidence-based recommendations for optimal dosing, interval timing, and administration methods are currently lacking.…”

“…To our knowledge, there is a relative paucity of high-quality studies evaluating the efficacy of therapeutic options for refractory disease. Options generally include glucocorticoids, antimalarials, methotrexate, tetracyclines, and systemic TNF-α inhibitors, although to our knowledge there are no studies exploring disease alteration specifically with certolizumab …”

“…Studies suggest that tumor necrosis factor–α (TNF-α) plays a prominent role in the pathogenesis of sarcoidosis via interferon γ–induced macrophage activation . While uncommon, intralesional TNF-α blockade has been shown to be effective in several granulomatous conditions, theoretically due to a higher targeted therapeutic effect with lower incidence of systemic adverse effects …”