TNF-α Inhibitor-Induced Psoriasis and Psoriatic Alopecia in Adolescent with Ulcerative Colitis: Clinical Case

Eduard T. Ambarchyan, Vladislav V. Ivanchikov, Anna L. Arakelyan, Andrey N. Surkov, Anastasia D. Kuzminova, Evgeny E. Bessonov, Elena V. Komarova
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Abstract

Background . Genetically engineered biological therapy has revolutionized the treatment of many chronic inflammatory diseases. It often allows to achieve significant clinical effect and improve the patient's quality of life. However, sometimes it leads to adverse events, and physicians encounter them more often. One of such side effects is paradoxical psoriasis (PP) that can be revealed during the therapy with tumor necrosis factor alpha (TNF-α) inhibitors. PP is the debut or exacerbation of pre-existing psoriasis. Clinical case description . Patient A., 17 years old, has suffered from ulcerative colitis since 2020; biological therapy with infliximab has been initiated in March 2022. Numerous rashes were revealed, as well as development of confluent alopecia foci on the background of scalp psoriatic damage, during the next hospitalization in December 2022. The patient was examined by dermatologist; diagnosis of PP was established according to the clinical picture and medical history. Skin rashes progressed and ulcerative colitis worsened (diarrheal syndrome, fecal calprotectin levels increased up to 526 μg/g) after cessation of infliximab therapy. Biological therapy with the inhibitor IL-12/23 (ustekinumab) was initiated due to the aggressive cutaneous pathological process and the aggravation of inflammatory bowel disease (IBD) symptoms. The gradual regression of rashes with the restoration of scalp hair growth and ulcerative colitis clinical and laboratory remission were noted during the treatment. Conclusion. PP is a rare complication that develops during therapy with TNF-α inhibitors, and it is most often observed in patients with IBD. In our case there was aggressive course of psoriasis with severe scalp lesion and hair loss (it is specific type of lesion in such patients). The ustekinumab, inhibitor IL-12/23, treatment efficacy correlates with the literature data on this drug successful use in both nosologies. Ustekinumab can be a first-line therapy in such pediatric patients. This clinical case is the first case in the Russian literature on effective management of PP and ulcerative colitis with ustekinumab in children.
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TNF-α抑制剂诱导的青少年溃疡性结肠炎银屑病和银屑病性脱发的临床研究
背景。基因工程生物疗法已经彻底改变了许多慢性炎症性疾病的治疗。往往可以取得显著的临床效果,提高患者的生活质量。然而,有时它会导致不良事件,医生更经常遇到它们。其中一个副作用是悖论性牛皮癣(PP),可以在肿瘤坏死因子α (TNF-α)抑制剂治疗期间显示。PP是原有牛皮癣的首发或加重。临床病例描述。患者A, 17岁,自2020年以来患有溃疡性结肠炎;英夫利昔单抗的生物治疗已于2022年3月开始。在2022年12月的下一次住院期间,发现了许多皮疹,并在头皮银屑病损伤的背景下发展为合流性斑秃。皮肤科医生对患者进行了检查;根据临床表现和病史确定PP的诊断。停止英夫利昔单抗治疗后,皮疹进展,溃疡性结肠炎恶化(腹泻综合征,粪便钙保护蛋白水平升高至526 μg/g)。由于侵袭性皮肤病理过程和炎症性肠病(IBD)症状加重,开始使用抑制剂IL-12/23 (ustekinumab)进行生物治疗。在治疗期间,随着头皮毛发生长的恢复,皮疹逐渐消退,溃疡性结肠炎的临床和实验室缓解。结论。PP是一种罕见的并发症,在TNF-α抑制剂治疗期间发生,最常见于IBD患者。在我们的病例中,银屑病病程严重,伴有严重的头皮损伤和脱发(这是此类患者的特殊病变类型)。ustekinumab,抑制剂IL-12/23,治疗效果与该药物在两种疾病中成功使用的文献数据相关。Ustekinumab可作为此类儿科患者的一线治疗。该临床病例是俄罗斯文献中第一例使用ustekinumab有效治疗儿童PP和溃疡性结肠炎的病例。
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来源期刊
Voprosy Sovremennoi Pediatrii - Current Pediatrics
Voprosy Sovremennoi Pediatrii - Current Pediatrics Medicine-Pediatrics, Perinatology and Child Health
CiteScore
0.70
自引率
0.00%
发文量
48
审稿时长
8 weeks
期刊介绍: The main purpose of the academic journal "Current Pediatrics" is to cover the issues related to health, emotional state, and social adaptation of children. In the journal we publish the most pressing issues of research and applied problems (such as social paediatrics; clinical findings, anamnesis, and diagnosis of paediatric diseases; prevention and rehabilitation; supply of healthy and sick child), reviews on the current state of medical science and management of health care in Russia. Along with the concern for providing a high level of basic research publications, the journal, being a mass media tool, tends to meet the interests and requirements of practitioners from different regions and bring up vital and urgent questions. To accomplish this purpose the journal includes the materials of practical interest presented in the following sections: "Exchange of experience", "Doctor''s aid", "Continuous professional education", "Expert Opinion". The journal presents actual official information from the Union of Paediatricians of Russia and publishes materials on the history of medical science, congresses, seminars, conferences, both in our country and abroad.
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