Paradoxical psoriasis: The flip side of idiopathic psoriasis or an autocephalous reversible drug reaction?

IF 4.7 Q2 IMMUNOLOGY Journal of Translational Autoimmunity Pub Date : 2023-09-06 DOI:10.1016/j.jtauto.2023.100211
Jiawei Lu, Yan Lu
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Abstract

Psoriasis is a common, chronic skin disease that results mainly from the complex interplay between T cells, dendritic cells, and inflammatory cytokines including TNF-α, IL-17, IL-12, and IL-23. Successful therapy with anti-cytokine antibodies has proved the importance of these key cytokines, especially TNF-α. During the anti-TNF-α treatment of classical idiopathic psoriasis, a small portion of patients develop new psoriasiform lesions. This contradictory phenomenon was named paradoxical psoriasis which resembles idiopathic psoriasis clinically but presents overlapped histological patterns and distinct immunological processes. In this review, we discuss the differences between idiopathic psoriasis and paradoxical psoriasis with an emphasis on their innate immunity, as it is predominant in paradoxical psoriasis which exhibits type I IFN-mediated immunity without the activation of autoreactive T cells and memory T cells. We also put up an instructive algorithm for the management of paradoxical psoriasis. The decision on drug discontinuation or switching of biologics should be made based on the condition of underlying diseases and the severity of lesions.

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矛盾型牛皮癣:特发性牛皮癣的另一面还是自体可逆药物反应?
银屑病是一种常见的慢性皮肤病,主要由T细胞、树突状细胞和炎性细胞因子(包括TNF-α、IL-17、IL-12和IL-23)之间复杂的相互作用引起。抗细胞因子抗体的成功治疗已经证明了这些关键细胞因子,特别是TNF-α的重要性。在经典特发性银屑病的抗tnf -α治疗过程中,一小部分患者出现新的银屑病样病变。这种矛盾的现象被命名为悖论型牛皮癣,它在临床上类似于特发性牛皮癣,但表现出重叠的组织学模式和不同的免疫过程。在这篇综述中,我们讨论了特发性银屑病和悖论型银屑病之间的差异,重点是它们的先天免疫,因为它在悖论型银屑病中占主导地位,表现出I型ifn介导的免疫,而不激活自身反应性T细胞和记忆T细胞。本文还提出了一种具有指导意义的治疗矛盾性牛皮癣的算法。停药或切换生物制剂的决定应根据潜在疾病的情况和病变的严重程度作出。
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来源期刊
Journal of Translational Autoimmunity
Journal of Translational Autoimmunity Medicine-Immunology and Allergy
CiteScore
7.80
自引率
2.60%
发文量
33
审稿时长
55 days
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