Clinical and histopathological characterization of paradoxical head and neck erythema in patients with atopic dermatitis treated with dupilumab: a case series.
Clinical and histopathological characterization of paradoxical head and neck erythema in patients with atopic dermatitis treated with dupilumab: a case series.
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DOI：
10.1111/bjd.18730
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发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Hijnen DJ
中科院分区：
文献类型：
--
作者：
de Wijs LEM;Nguyen NT;Kunkeler ACM;Nijsten T;Damman J;Hijnen DJ
Dupilumab是首个注册用于治疗特应性皮炎（AD）的生物制剂。我们报告了7例AD患者，在dupilumab治疗开始后10-39周出现反常的头颈部红斑。患者在头部和颈部出现相对清晰的片状红斑，与他们通常的湿疹相比，没有或很少出现鳞屑。只有1例患者出现瘙痒和烧灼感症状，尽管这与其先前存在的面部AD明显不同。除了一个明显的“红脸”，其他身体部位的湿疹有很大的改善，在7名患者中的6名，与治疗满意度的平均数字评级量表的9个10活检时。用局部和全身药物治疗红斑不成功。尽管存在该红斑，但我们的患者均未停止dupilumab治疗。皮损皮肤活检显示扩张毛细血管数量增加，血管周围淋巴组织细胞浸润。此外，在4名患者中观察到表皮增生伴网脊延长，类似银屑病样皮炎。其他免疫组化染色显示浆细胞、组织细胞和T淋巴细胞数量增加。有趣的是，在所有活检中基本上不存在海绵状增生。我们报告了接受dupilumab治疗的AD患者在头颈部出现反常红斑。在临床和组织病理学上，我们发现了异质性反应，这最可能提示药物诱导的皮肤反应。 关于这个话题我们已经知道了什么？ Dupilumab已被证明是一种有效治疗特应性皮炎的药物，具有可接受的安全性特征。在接受dupilumab治疗的特应性皮炎患者中，最常见的副作用为结膜炎、疱疹感染和注射部位反应。 这项研究增加了什么？ 我们首次报告了接受dupilumab治疗的特应性皮炎患者，他们在头部和颈部出现了反常的、主要是无症状的红斑。皮肤活检的组织学检查显示银屑病样反应模式，提示药物诱导的皮肤反应。
Dupilumab is the first biologic registered for the treatment of atopic dermatitis (AD). We report on seven patients with AD presenting with a paradoxical head and neck erythema that appeared 10–39 weeks after the start of dupilumab treatment. The patients presented with a relatively sharply demarcated, patchy erythema in the head and neck area that showed no or less scaling compared with their usual eczema. Only one patient experienced symptoms of itch and burning, although this was notably different from his pre‐existent facial AD. Except for a notable ‘red face’, eczema on other body parts had greatly improved in six of the seven patients, with a mean numerical rating scale for treatment satisfaction of 9 out of 10 at the time of biopsy. Treatment of the erythema with topical and systemic drugs was unsuccessful. Despite the presence of this erythema, none of our patients discontinued dupilumab treatment. Lesional skin biopsies showed an increased number of ectatic capillaries, and a perivascular lymphohistiocytic infiltration in all patients. In addition, epidermal hyperplasia with elongation of the rete ridges was observed in four patients, resembling a psoriasiform dermatitis. Additional immunohistochemical stainings revealed increased numbers of plasma cells, histiocytes and T lymphocytes. Interestingly, spongiosis was largely absent in all biopsies. We report on patients with AD treated with dupilumab developing a paradoxical erythema in a head and neck distribution. Both clinically and histopathologically we found a heterogeneous response, which was most suggestive of a drug‐induced skin reaction. What's already known about this topic? Dupilumab has proven to be an efficacious and effective treatment for atopic dermatitis with an acceptable safety profile. The most frequently observed side‐effects in patients with atopic dermatitis treated with dupilumab are conjunctivitis, herpes infections and injection‐site reactions. What does this study add? For the first time, we report on patients with atopic dermatitis treated with dupilumab who developed a paradoxical, mainly asymptomatic erythema in a head and neck distribution. Histological examination of skin biopsies revealed a psoriasiform reaction pattern suggestive of a drug‐induced skin reaction.
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影响因子：
30.3
作者：
Sparber, Florian;De Gregorio, Corinne;LeibundGut-Landmann, Salome
通讯作者：
LeibundGut-Landmann, Salome
DOI：
10.1038/nrdp.2016.82
发表时间：
2016-11-24
期刊：
Nature reviews. Disease primers
影响因子：
--
作者：
Greb, Jacqueline E;Goldminz, Ari M;Gottlieb, Alice B
通讯作者：
Gottlieb, Alice B
DOI：
10.1007/978-3-642-03616-3_3
发表时间：
2010-01-01
期刊：
MALASSEZIA AND THE SKIN: SCIENCE AND CLINICAL PRACTICE
影响因子：
--
作者：
Sugita, Takashi;Boekhout, Teun;Cabanes, F. Javier
通讯作者：
Cabanes, F. Javier
影响因子：
2.8
作者：
Weyers W;Metze D
通讯作者：
Metze D
影响因子：
81.5
作者：
Weidinger, Stephan;Beck, Lisa A.;Irvine, Alan D.
通讯作者：
Irvine, Alan D.