Paradoxical psoriasiform reactions to antitumour necrosis factor‐α drugs in hidradenitis suppurativa

Dequidt, L.; Cogrel, O.; Guillet, S.; Milpied, B.; Darrigade, A.-S.; Beylot‐Barry, M.; Pham‐Ledard, Anne

doi:10.1111/bjd.15616

Cited by 14 publications

(14 citation statements)

References 10 publications

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“…11,32 It should be noted that biological therapy is associated with paradoxical development of HS in a few patients with psoriasis and paradoxical psoriasis in a minority of patients with HS. 33 In South Korean patients, an association was demonstrated between HS and ankylosing spondylitis (OR 1Á47, 95% CI 1Á14-1Á89) and rheumatoid arthritis (OR 1Á31, 95% CI 1Á16-1Á47). 11 Among commercially insured patients in the USA, longitudinal claims data showed that patients with HS had an increased risk of developing ankylosing spondylitis compared with those without HS [hazard ratio (HR) 1Á65, 95% CI 1Á15-2Á35].…”

Section: Chronic Inflammatory Diseasesmentioning

confidence: 97%

The epidemiology of hidradenitis suppurativa*

Ingram¹

2020

Br. J. Dermatol.

123

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Summary Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease defined clinically by multiple, painful inflammatory lesions occurring predominantly in flexural sites. Onset is typically soon after puberty; however, it remains unknown whether the menopause induces remission. In North American and European patients with HS the female‐to‐male ratio is approximately 3 : 1 but the ratio is 1 : 2 in South Korean patients. It may be that some elements of HS epidemiology cannot be generalized across all populations. Elements of HS epidemiology in the USA and Europe are well established, including strong associations with obesity and smoking, which may increase disease severity. There are associations between HS and other cardiovascular disease (CVD) risk factors, including type 2 diabetes and metabolic syndrome. People with HS have double the risk of death from CVD compared with those without HS and 1·5 times the risk compared with patients with psoriasis. Depression and anxiety are associated with HS and completed suicide rates in those with HS are more than double the rates in controls. Associations exist between HS and other chronic inflammatory conditions, particularly inflammatory bowel disease and inflammatory arthritis. Case–control studies demonstrate associations with pilonidal sinus, polycystic ovary syndrome, Down syndrome, obstructive sleep apnoea and pyoderma gangrenosum. Population‐based studies using routinely collected healthcare data from the USA estimate a prevalence of 0·1%, suggesting HS is relatively uncommon. European studies include undiagnosed patients and typically estimate prevalence of 1% or more, suggesting a common condition. Resolving the controversy surrounding a greater than 10‐fold difference in HS prevalence estimates remains a high priority.

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Section: Chronic Inflammatory Diseasesmentioning

confidence: 97%

The epidemiology of hidradenitis suppurativa*

Ingram¹

2020

Br. J. Dermatol.

123

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“…Paradoxical psoriasiform reactions in HS patients treated with tumor necrosis factor alpha (TNFα) antagonists have been reported to occur in up to 19.5% of cases, 1 and are often characterized by psoriasiform lesions, palmoplantar pustulosis and severe involvement of the scalp that may lead to alopecia.…”

Section: Figurementioning

confidence: 99%

“…Almost 50% of patients with paradoxical reactions require withdrawal of anti‐TNFα agents due to the severity of the lesions and remain refractory to systemic treatments, 1 thus becoming a therapeutic challenge.…”

Section: Figurementioning

confidence: 99%

Sequential paradoxical psoriasiform reaction and sacroiliitis following adalimumab treatment of hidradenitis suppurativa, successfully treated with guselkumab

Garcia‐Melendo

Vilarrasa

Cubiró

et al. 2020

Dermatologic Therapy

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Paradoxical reactions during treatment with a biologic agent are defined by the appearance or exacerbation of a pathological condition that usually responds to this drug while treating another condition. A 26-year-old woman presented with a 3-year history of Hurley Stage III hidradenitis suppurativa (HS) involving the groin, buttocks, and pubis, which had been refractory to topical antibiotics and corticosteroids, doxycycline, rifampicin, and clindamycin in combination. F I G U R E 1 Hurley stage III Hidradenitis suppurativa and paradoxical psoriasiform reaction to adalimumab. A,B, Inflammatory nodules and abscesses in the groin and pubis (Hurley Stage III, Physician's Global Assessment 4) together with erythemato-desquamative plaques on the legs and C, palms with pustules and D, extensive alopecia patches on the scalp secondary to desquamative plaques. Because of the severity of hair loss, the patient herself shaved the remaining hair and had to wear a wig.

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“…PPRs have been reported to occur in up to 19.5% of patients suffering from HS when they are treated with anti-TNF-a agents [9]. Their clinical manifestations include typical psoriasiform lesions, palmoplantar pustulosis, and severe involvement of the scalp leading to alopecia [9, 10]. These PPRs are probably related to the depletion of TNF and represent an ongoing type-I interferon-driven innate inflammatory process [11].…”

Section: Discussionmentioning

confidence: 99%

Clinical and Epidemiological Characteristics of Hidradenitis Suppurativa Patients with Paradoxical Psoriasiform Reactions following Treatment with Adalimumab

Κανελλέας

Efthymiou

Routsi

et al. 2022

Skin Appendage Disord

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Introduction: Immunomodulation using TNF-α inhibitors (anti-TNF-a), especially adalimumab, is highly effective in the treatment of hidradenitis suppurativa (HS) in cases that are poorly controlled by conventional treatments. However, paradoxical psoriasis represents a peculiar type of psoriasis that may occur de novo or as the worsening of pre-existent psoriatic lesions during treatment with adalimumab. Case Presentation: We reported 4 cases of patients suffering from HS, who developed paradoxical psoriasis after treatment with adalimumab for their HS, analyzing their clinical and epidemiological characteristics. All 4 cases were middle aged, smokers, overweight or obese. Half of the patients were males (50%). All of them were classified as Hurley stage III, with a mean duration of HS of 20 years. Two patients had a family history of psoriasis. All 4 patients had been on at least 5 months of successful treatment with adalimumab before the onset of the lesions. Conclusions: Paradoxical psoriasis emerged in 4 patients who received at least 5-month regimen of adalimumab for long-lasting HS. Although different mechanisms have been hypothesized for such events, the exact underlying pathogenetic pathway remains unclear. Consistent reporting of such rare cases, and on a larger scale, is encouraged in order to enrich the available literature.

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Paradoxical psoriasiform reactions to antitumour necrosis factor‐α drugs in hidradenitis suppurativa

Cited by 14 publications

References 10 publications

The epidemiology of hidradenitis suppurativa*

The epidemiology of hidradenitis suppurativa*

Sequential paradoxical psoriasiform reaction and sacroiliitis following adalimumab treatment of hidradenitis suppurativa, successfully treated with guselkumab

Clinical and Epidemiological Characteristics of Hidradenitis Suppurativa Patients with Paradoxical Psoriasiform Reactions following Treatment with Adalimumab

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