使用辉瑞-生物技术公司生产的 COVID-19 疫苗后,红斑狼疮得到阿曲汀和杜匹单抗的成功治疗

Raquel Hoopes, Ellen De Moll
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摘要

导言:红斑性脓疱病(PRP)是一种原因不明的炎性溃疡;COVID-19疫苗诱发PRP的病例很少见。在此,我们介绍了一例 COVID-19 疫苗诱发的红斑性脓疱疮病例,该病例使用阿曲汀治疗效果不佳,但使用 IL-4/IL-13 抑制剂杜必鲁单抗治疗后获得成功。病例报告:一名 76 岁的男性患者到皮肤科门诊就诊,2 个月前开始出现严重瘙痒性皮疹,皮疹不断恶化,其特征是大面积橘橙色毛囊性丘疹,鳞屑凝聚成斑块,覆盖约 80% 的体表面积。斑块边界清晰,并有多个PRP特有的疏松岛。患者尝试了多种疗法,包括口服泼尼松、霉酚酸盐、外用皮质类固醇激素、抗寄生虫药、抗真菌药、多虑平和紫外线照射疗法,但效果不佳。口服阿曲汀的试验使皮肤斑块和角化病有所改善,但患者仍然出现难以控制的瘙痒。开始使用杜比鲁单抗后,病情迅速得到缓解,几个月来患者的病情一直没有复发。结论:临床医生应了解杜匹单抗可有效治疗 PRP 顽固性瘙痒症。
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Pityriasis Rubra Pilaris Following Administration of the Pfizer-BioNTech COVID-19 Vaccine Successfully Treated with Acitretin and Dupilumab
Introduction: Pityriasis rubra pilaris (PRP) is an inflammatory eruption of unknown origin; rare cases of COVID-19 vaccine-induced PRP have been reported. Here, we present a case of COVID-19 vaccine-induced pityriasis rubra pilaris inadequately managed with acitretin, successfully treated with the IL-4/IL-13 inhibitor dupilumab. Case Report: A 76-year-old male presented to an outpatient dermatology clinic with a 2-month history of a profoundly pruritic worsening rash characterized by large, orange-salmon-colored follicular papules with scale coalescing into plaques covering approximately 80% of the body surface area. The plaques had well-defined borders and multiple islands of sparing characteristic of PRP. Multiple therapies were trialed with no improvement, including oral prednisone, mycophenolate, topical corticosteroids, antiparasitics, antifungals, doxepin, and UVB treatments. A trial of oral acitretin resulted in improvement of the skin plaques and keratoderma, but the patient remained uncontrollably pruritic. Dupilumab was initiated which provided rapid relief, and the patient has remained clear for several months. Conclusion: Clinicians should be aware of dupilumab’s potential for effective treatment of PRP with recalcitrant pruritus. 
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