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Journal articles on the topic 'Paradoxical Psoriasis'

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Author: Grafiati

Published: 11 March 2023

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1

Vender, Reid, and Ronald Vender. "Paradoxical, Cupping-Induced Localized Psoriasis: A Koebner Phenomenon." Journal of Cutaneous Medicine and Surgery 19, no. 3 (March 13, 2015): 320–22. http://dx.doi.org/10.2310/7750.2014.14109.

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Background Cupping therapy is a traditional Chinese medicine used to heal psoriasis. The Koebner phenomenon is the occurrence of psoriatic lesions at the site of cutaneous injury. Objective To describe the first case of biopsy-proven cupping-induced localized psoriasis, an example of the Koebner phenomenon. Methods The histopathology of the lesions is described. A brief review of the literature regarding cupping therapy and its efficacy are discussed. Results A 45-year-old Asian male presented himself to the dermatology clinic for further treatment of his psoriasis. Four unusually circular plaques on the lower back were discovered. Pathologic diagnosis revealed an early lesion of psoriasis. on further inquiry, the patient admitted to undergoing a recent ‘'cupping'’ procedure in an attempt to cure his condition. Conclusion The efficacy of cupping therapy is controversial, and psoriatic patients may develop localized psoriasis through koebnerization as a result of cupping therapy rather than achieve desirable therapeutic benefits.

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2

Bucalo, Agostino, Federica Rega, Arianna Zangrilli, Valentina Silvestri, Virginia Valentini, Giorgia Scafetta, Federica Marraffa, et al. "Paradoxical Psoriasis Induced by Anti-TNFα Treatment: Evaluation of Disease-Specific Clinical and Genetic Markers." International Journal of Molecular Sciences 21, no. 21 (October 23, 2020): 7873. http://dx.doi.org/10.3390/ijms21217873.

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Paradoxical psoriasis (PP) may occur during treatment with anti-tumor necrosis factor-alpha (TNF-α) drugs in various chronic immune-mediated diseases, mainly inflammatory bowel diseases (IBD) and psoriasis. In this study, clinical and genetic characteristics of PP arising in IBD and psoriatic patients were investigated to identify disease-specific markers of the paradoxical effect. A total of 161 IBD and psoriatic patients treated with anti-TNF-α drugs were included in the study. Of these patients, 39 developed PP. All patients were characterized for the main clinical–pathologic characteristics and genotyped for six candidate single nucleotide polymorphisms (SNPs) selected for their possible role in PP susceptibility. In IBD patients, the onset of PP was associated with female sex, presence of comorbidities, and use of adalimumab. IBD patients with PP had a higher frequency of the TNF-α rs1799964 rare allele (p = 0.006) compared with cases without the paradoxical effect, and a lower frequency of the human leucocyte antigen (HLA)-Cw06 rs10484554 rare allele (p = 0.03) compared with psoriatic patients with PP. Overall, these findings point to specific clinical and genetic characteristics of IBD patients with PP and provide data showing that genetic variability may be related to the paradoxical effect of anti-TNF-α drugs with possible implications into clinical practice.

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3

Giovanna Brunasso, Alexandra Maria, and Cesare Massone. "Paradoxical Psoriasis During IL-17 Blockage: Two Memorable Patients." Dermatology and Dermatitis 6, no. 2 (August 13, 2021): 01–02. http://dx.doi.org/10.31579/2578-8949/080.

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47 year-old man who suffered for plaque psoriasis since 2013 was previously treated with topicals, UVB photherapy, acitretin, methotrexate and adalimumab (Imraldi®) with scarce response. Brodalumab (IL-17 receptor chain A blocking antibody) at 210 mg sc day 0, week-1, week-2 and every 2 weeks was initiated (baseline PASI of 16) with fast improvement of psoriasis (PASI-90 at week 4) and new onset of erythema, pustules and pain in the palmoplantar area after each subcutaneous Brodalumab administration and progressive improvement after 5-8 days.

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4

ZEKEY, Emre, Pinar KARABAGLİ, and Gülcan SAYLAM KURTİPEK. "Adalimumab induced severe paradoxical psoriasis in a patient with ankylosing spondylitis." Cukurova Medical Journal 47, no. 4 (December 28, 2022): 1768–70. http://dx.doi.org/10.17826/cumj.1170774.

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Anti-tumor necrosis factor (Anti-TNF)’s have been used frequently in rheumatology and dermatology. These drugs may couse psoriasiform lesions paradoxically. In this report, ankylosing spondylitis patient who developed severe paradoxical psoriasis while being treated with adalimumab was discussed.

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5

Alaou, Rhita, Sofia Alami, Nawal Lagdali, Maryeme Kadiri, Camélia Berhili, Fatima-Zahra Chabib, Mohamed Borahma, Imane Benelbarhdadi, and Fatima-Zahra Ajana. "Paradoxical cutaneous manifestations induced by TNF inhibitors in patients with inflammatory bowel disease." Our Dermatology Online 14, no. 1 (January 2, 2023): 60–64. http://dx.doi.org/10.7241/ourd.20231.12.

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Background: Anti-TNF drugs have revolutionized the management of numerous inflammatory diseases, yet they may produce paradoxical effects. Materials and Methods: A descriptive study was conducted on patients with chronic inflammatory bowel disease (IBD) on anti-TNF therapy who had developed paradoxical psoriasis. Results: Out of a total of 218 patients followed for IBD on TNF inhibitors, five presented with paradoxical psoriasis. In four patients, a specific treatment for psoriasis was associated with anti-TNF treatment. In one patient, a swap to ustekinumab was decided. Good progress was noted in four patients. In one, there was no improvement of the psoriasis on methotrexate, which was switched to another anti-TNF agent. Conclusion: In our experience, TNF inhibitor-induced psoriasis is relatively rare (prevalence of 2.3%). The choice of treatment is reached by assessing the benefit-risk balance. Key words: Paradoxical cutaneous manifestations; TNF inhibitors; Cutaneous manifestations; Inflammatory bowel disease

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6

McFeely, O., E. Pender, L. Victory, H. Almutlaq, and E. Storan. "Risankizumab‐induced paradoxical pustular psoriasis." Clinical and Experimental Dermatology 47, no. 3 (December 10, 2021): 616–17. http://dx.doi.org/10.1111/ced.15006.

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7

Dogra, S., A. Bishnoi, T. Narang, and S. Handa. "Secukinumab-induced paradoxical pustular psoriasis." Clinical and Experimental Dermatology 44, no. 1 (August 20, 2018): 72–73. http://dx.doi.org/10.1111/ced.13731.

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8

Boch, Katharina, Detlef Zillikens, Ralf J. Ludwig, and Diamant Thaçi. "Paradoxical improvement of life quality in the COVID-19 era in psoriasis patients." PLOS ONE 17, no. 9 (September 27, 2022): e0275293. http://dx.doi.org/10.1371/journal.pone.0275293.

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Background Psoriasis is a chronic immune-mediated inflammatory disease. Beyond the physical dimensions, the disease has an extensive emotional and psychosocial effect on patients, influencing their quality of life, social life and interpersonal relationships. Thus patient-reported outcomes are a crucial instrument for the evaluation of disease burden. Navigating life in times of the COVID-19 pandemic is challenging, especially for persons suffering from chronic diseases. We here analyzed the impact of lockdown restrictions on psoriasis patients. Objective To compare the Dermatology Life Quality Index (DLQI) before and during the COVID-19 pandemic of patients with psoriasis. Methods Retrospective longitudinal analysis in adult patients with moderate to severe psoriasis undergoing biologic treatment between January 2020 and January 2021. DLQI, patient demographics, Psoriasis Area and Severity Index (PASI), and recent biologic treatment were recorded. Results 103 patients were identified, of whom 19 had additional psoriatic arthritis. Female (n = 29) and male (n = 74) patients were distributed 1 to 3. Median age of patients was 54 years (range 18–85). All patients received biologic systemic treatment: anti-IL-23 (n = 39), anti-IL-17A (n = 30), anti-IL-12/23 (n = 25), or anti-TNFα (n = 9). Comparing DLQI scores before the COVID-19 pandemic and under lockdown restriction showed improved DLQI scores over time. Further analysis displayed that patients mostly ticked “not relevant” on social activities during lockdown. Thus, the DLQI scores may be artificial improved and may not really reflect the actual disease burden. Conclusions Psoriasis patients showed a contrary improvement of life quality despite harsh COVID-19 lockdown suggesting that DLQI should be modified when social life is restricted.

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9

Ürün, Yıldız Gürsel, Hande Yelgen, Mustafa Ürün, and Nuray Can. "Secukinumab-induced paradoxical palmoplantar pustular psoriasis." TURKDERM 56, no. 4 (December 31, 2022): 197–99. http://dx.doi.org/10.4274/turkderm.galenos.2022.39591.

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10

Megna, Matteo, Sonia Sofia Ocampo-Garza, Luca Potestio, Giuseppina Fontanella, Lucia Gallo, Sara Cacciapuoti, Angelo Ruggiero, and Gabriella Fabbrocini. "New-Onset Psoriatic Arthritis under Biologics in Psoriasis Patients: An Increasing Challenge?" Biomedicines 9, no. 10 (October 15, 2021): 1482. http://dx.doi.org/10.3390/biomedicines9101482.

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Psoriasis and psoriatic arthritis (PsA) development is sustained by tumor necrosis factor (TNF)α, interleukin (IL)17, and IL23; hence, biologics targeting those cytokines represent useful therapeutic weapons for both conditions. Nevertheless, biologics strongly reduce PsA risk; several studies reported the possibility of new-onset PsA during biologic therapy for psoriasis. The aim of this 1-year prospective study is to evaluate the prevalence of paradoxical PsA in psoriasis patients under biologic therapy and review the existing literature. For each patient, age, sex, psoriasis duration, psoriasis severity, comorbidities, and previous and current psoriasis treatments were collected, and each subject was screened for PsA using the Early ARthritis for Psoriatic patient (EARP) questionnaire every 3 months for 1 year. New-onset PsA was diagnosed in 10 (8.5%) out of 118 patients (three male, 30.0%; mean age 44.5 years) involving every different biologic class (anti-TNF, anti-IL12/23, anti-IL17, and anti-IL23). No significant risk factor for new-onset PsA was identified; no significant difference was found comparing patients who developed PsA and subjects who did not develop PsA regarding psoriasis severity, past/current therapies, and comorbidities. Clinicians must keep in mind the possibility of PsA onset also in patients undergoing biologics so that PsA screening should be strongly recommended at each follow-up.

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11

Tadiotto Cicogna, Giulia, Francesco Messina, Linda Nalotto, Serena Szekely, and Mauro Alaibac. "Case Report: Paradoxical acrodermatitis of Hallopeau-like eruption following anti-IL-17 therapy." F1000Research 8 (March 26, 2019): 336. http://dx.doi.org/10.12688/f1000research.18493.1.

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Psoriasis is a chronic immune-mediated inflammatory disease. Up to 40% of patients with psoriasis may develop psoriatic arthritis. Currently, interleukin (IL)-17/IL-23 pathways are identified as key factors in the immunopathogenesis of both conditions. Here we describe the case of a patient who developed psoriasiform skin lesions 10 months after the initiation of anti-IL17 therapy for psoriatic arthritis. The underlying disease had responded well to the therapy, but the patient developed a striking pustular eruption at the fingers with nail involvement, onycholysis, yellow discoloration, and subungual keratosis. Clinical and histological findings were consistent with an acrodermatitis continua of Hallopeau-like eruption. Skin lesions subsided after discontinuation of the responsible anti-IL17 agent. The interpretation of this paradoxical side effect of biological therapies remains unclear but may relate to an unbalanced inflammatory cytokine response induced by the inhibition of TNF activity. It is likely that patients, who are genetically prone, may respond exaggeratedly to a cytokine imbalance. The identification of this kind of patient, in the future, could be useful in order to choose the correct therapy.

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Ferraresso, María Guillermina, María Luz Bollea Garlatti, Lourdes María Perez-Chada, Mariana Soledad Martin, and Luis Daniel Mazzuoccolo. "Certolizumab-Induced Paradoxical Psoriatic Alopecia." Journal of Psoriasis and Psoriatic Arthritis 5, no. 3 (July 2020): 86–92. http://dx.doi.org/10.1177/2475530320928625.

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Introduction: Biologic drugs have revolutionized the treatment of chronic inflammatory immunologic diseases. However, their use is associated with adverse reactions, including paradoxical adverse events. Tumor necrosis factor (TNF)–associated psoriatic alopecia (TiAPA) is a paradoxical adverse event that has been rarely reported in the literature. Only 1 case secondary to certolizumab has been recently described. Case Presentation: We described a case of scalp alopecia secondary to certolizumab in a 27-year old female patient with Crohn disease. The skin biopsy showed psoriasiform changes and loss of sebaceous lobule compatible with TiAPA. The patient presented significant improvement in the clinical findings and hair regrowth after 4 weeks of treatment with clobetasol unguent 0.05% and discontinuation of certolizumab. Months later she received infliximab for her Crohn disease, achieving good control of the illness until today. Discussion: This is a paradoxical adverse event that has been rarely reported in the literature. Most of the cases were related with infliximab and adalimumab. There is no standard approach for the management of TNF inhibitor–induced psoriasis, but around 20% require discontinuation of treatment. Conclusions: The recognition of anti-TNF drug–induced alopecia has allowed description of a new form of alopecia, clinically and histologically mimicking primary psoriatic alopecia with the recently described finding of loss of sebaceous lobules. Recognizing this form of alopecia can enable effective treatment while allowing, in most cases, anti-TNF therapy to continue.

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13

Fauny, Marine, David Moulin, Ferdinando D'Amico, Patrick Netter, Nadine Petitpain, Djesia Arnone, Jean-Yves Jouzeau, Damien Loeuille, and Laurent Peyrin-Biroulet. "Paradoxical gastrointestinal effects of interleukin-17 blockers." Annals of the Rheumatic Diseases 79, no. 9 (July 21, 2020): 1132–38. http://dx.doi.org/10.1136/annrheumdis-2020-217927.

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Secukinumab, ixekizumab and brodalumab are monoclonal antibody therapies that inhibit interleukin (IL)-17 activity and are widely used for the treatment of psoriasis, psoriatic arthritis and ankylosing spondylitis. The promising efficacy results in dermatology and rheumatology prompted the evaluation of these drugs in Crohn’s disease and ulcerative colitis, but the onset of paradoxical events (disease exacerbation after treatment with a theoretically curative drug) prevented their approval in patients with inflammatory bowel diseases (IBDs). To date, the pathophysiological mechanisms underlying these paradoxical effects are not well defined, and there are no clear guidelines for the management of patients with disease flare or new IBD onset after anti-IL-17 drug therapy. In this review, we summarise the literature on putative mechanisms, the clinical digestive effects after therapy with IL-17 inhibitors and provide guidance for the management of these paradoxical effects in clinical practice.

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14

Carriero, Antonio, Ennio Lubrano, Valentina Picerno, Angela Anna Padula, and Salvatore D’Angelo. "Paradoxical psoriatic arthritis in a patient with psoriasis treated with guselkumab." Clinical and Experimental Dermatology 47, no. 4 (January 5, 2022): 783–85. http://dx.doi.org/10.1111/ced.15061.

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15

Lee, Ho Yeol, Cheong Ha Woo, and Sik Haw. "Paradoxical Flare of Psoriasis after Ustekinumab Therapy." Annals of Dermatology 29, no. 6 (2017): 794. http://dx.doi.org/10.5021/ad.2017.29.6.794.

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16

Fernandes, Larissa Starling de A., Daniela Martinez, Omar Lupi, Ricardo Barbosa Lima, Carlos José Martins, and Antonio D'`Acri. "Paradoxical skin reaction with infliximab treatment." Medicina (Ribeirao Preto Online) 51, no. 1 (September 4, 2018): 82–86. http://dx.doi.org/10.11606/issn.2176-7262.v51i1p82-86.

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Considering the increased utilization of anti-TNF medications in the treatment of inflammatory and autoimmune diseases, dermatologists should be aware of the possible adverse skin reactions. We describe a case of inverted psoriasis due to the use of infliximab used in the treatment of inflammatory bowel disease.

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17

Zhukov, Alexander S., Alexander V. Patrushev, Vladislav R. Khairutdinov, Alexey V. Samtsov, and Evgeniy V. Kryukov. "New aspects of the pathogenesis of psoriasis." Vestnik dermatologii i venerologii 98, no. 4 (September 19, 2022): 31–40. http://dx.doi.org/10.25208/vdv1345.

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Psoriasis is a chronic multi-factorial immune-mediated inflammatory disease of skin and joints. The variety of clinical forms of dermatosis is consistent with various pathogenetic features of the disease progress which have been significantly supplemented and reviewed recently. Knowledge of these mechanisms will improve and personalize the prescribed therapy. This study places the emphasis on modern ideas about the formation of T cell memory, the role of melanocytes and innate lymphoid cells. Development mechanisms of guttate and paradoxical psoriasis with important distinguishing characteristics are described separately. Today, knowledge of the molecular basis of the disease progression has led to the creation and introduction of a number of highly effective targeted drugs into clinical practice. Further developments related to the inhibition of resident memory cells, innate lymphoid cells, as well as the study of guttate psoriasis perpetuation and the occurrence of paradoxical psoriasis will significantly increase the effectiveness of the therapy.

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Bruzzese, Vincenzo, Vincenzo De Francesco, Cesare Hassan, Roberto Lorenzetti, Palma Scolieri, Cinzia Marrese, and Angelo Zullo. "New onset or worsening of psoriasis following biologic therapy: A case series." International Journal of Immunopathology and Pharmacology 30, no. 1 (January 30, 2017): 70–72. http://dx.doi.org/10.1177/0394632016688221.

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Biologic therapies may cause so-called “paradoxical side-effects,” that is, the onset or exacerbation of new symptoms/diseases for which biological treatment should be effective. Among these, psoriatic skin lesions have been described. We report a case series of ten patients with either new onset (seven cases) or worsening (three cases) of psoriasis occurring during a biologic therapy. Six patients were receiving a biologic monotherapy, while four patients were in combination treatment with methotrexate (MTX). Psoriasis remission was observed in two patients who discontinued biologic therapy. In the six patients in whom biologic therapy was not discontinued, a complete disappearance or a partial improvement of skin lesions was achieved following topic steroid therapy in two patients and three patients, respectively. In the remaining patient, psoriasis developed during Adalimumab monotherapy, which completely disappeared when the Infliximab and MTX combination was started. The potential pathogenetic mechanisms were shortly reviewed.

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Abbruzzese, Anna, Vincenzo Venerito, Giuseppe Lopalco, Marco Fornaro, Maria Giannotta, and Florenzo Iannone. "Paradoxical Pustular Psoriasis in a Patient With Psoriatic Arthritis on Secukinumab Treatment." JCR: Journal of Clinical Rheumatology 26, no. 6 (June 13, 2019): e208-e209. http://dx.doi.org/10.1097/rhu.0000000000001076.

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20

Urushikubo, Jun, Keisuke Kawasaki, Makoto Eizuka, Shunichi Yanai, Shotaro Nakamura, Tamotsu Sugai, and Takayuki Matsumoto. "Ustekinumab Improves Paradoxical Enteropathy Associated With Psoriasis Arthritis." Inflammatory Bowel Diseases 25, no. 10 (July 13, 2019): e128-e129. http://dx.doi.org/10.1093/ibd/izz154.

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21

Mas-Vidal, Albert, Pablo Coto-Segura, Cristina Galache-Osuna, and Jorge Santos-Juanes. "Psoriasis induced by cetuximab: A paradoxical adverse effect." Australasian Journal of Dermatology 52, no. 1 (August 16, 2010): 56–58. http://dx.doi.org/10.1111/j.1440-0960.2010.00675.x.

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22

Yiu, Z. Z. N., F. R. Ali, and C. E. M. Griffiths. "Paradoxical exacerbation of chronic plaque psoriasis by sorafenib." Clinical and Experimental Dermatology 41, no. 4 (December 15, 2015): 407–9. http://dx.doi.org/10.1111/ced.12788.

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23

Ismail, Rasimah. "A Case Series Exploring the Efficacy, Secondary Failure, Paradoxical Event & Relapse with Ustekinumab Therapy in Chronic Plaque Psoriasis." Medicine & Health 15, no. 2 (December 31, 2020): 153–63. http://dx.doi.org/10.17576/mh.2020.1502.15.

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Ustekinumab is an anti-IL12/23 biologic agent used for treatment of psoriasis with excellent efficacy. However, there are therapeutic obstacles such as secondary failure and paradoxical event. Disease relapse upon discontinuation of therapy is common. A case series was performed on patients with chronic plaque psoriasis who received ustekinumab between 2013 to 2018 at a tertiary referral centre. Demographics, clinical characteristics, duration of therapy, efficacy, treatment complications, rate and pattern of relapses were determined from the patients’ medical records. Out of 8 patients, 6 (75%) patients were males. There were 6 (75%) biologic-naïve patients. Median age was 41.5 years (IQR26.8-48.3), median duration of psoriasis was 16.5 years (IQR6.5-23.0). Median duration to achieve Psoriasis Activity and Severity Index (PASI)75 was 16 weeks and median total duration of treatment was 102 weeks. All patients achieved treatment success. PASI75 at week 12 was achieved by 37.5%, a median of 16 weeks was required to achieve at least PASI 75 but 6 (75%) attained PASI 90 by then. One patient (12.5%) developed paradoxical event with pustular and plaques. Secondary failure occurred in 2 (25%) patients. All patients relapsed after treatment discontinuation, relapse occurred at median of 40 weeks. Most (71%) developed plaques on relapse but 25% developed plaques and pustules. All but one patient required further biological agent for treatment of relapse. Ustekinumab was efficacious in all patients. Treatment success was achieved slightly later than standard duration. The rare occurrences of secondary failure and paradoxical were observed. Relapse was inevitable, new onset pustular eruptions featured in relapses.

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24

Čarija, Antoanela, Ivo Ivić, Daniela Marasović-Krstulović, and Neira Puizina-Ivić. "Paradoxical psoriatic arthritis in a patient with psoriasis treated with ustekinumab: Table 1." Rheumatology 54, no. 11 (August 4, 2015): 2114–16. http://dx.doi.org/10.1093/rheumatology/kev263.

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25

Su, Peiqi, and Jiun Yit Pan. "Paradoxical flare of psoriasis, psoriatic spondyloarthritis, and psoriatic uveitis after switching from infliximab to secukinumab." Dermatologica Sinica 35, no. 2 (June 2017): 112–13. http://dx.doi.org/10.1016/j.dsi.2016.10.002.

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26

Uchida, Shusuke, Naoki Oiso, Yoriaki Komeda, Masatoshi Kudo, and Akira Kawada. "Paradoxical ulcerative colitis during treatment with secukinumab for psoriasis." European Journal of Dermatology 29, no. 4 (August 2019): 444–45. http://dx.doi.org/10.1684/ejd.2018.3391.

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27

Bordel-Gómez, MT, J. Sánchez-Estella, O. Martínez-González, and MªE Cardeñoso-Álvarez. "Palmoplantar psoriasis: a paradoxical adverse reaction induced by adalimumab." Journal of the European Academy of Dermatology and Venereology 23, no. 4 (April 2009): 444–45. http://dx.doi.org/10.1111/j.1468-3083.2008.02898.x.

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28

Suh, Hyun Yi, Ji Young Ahn, Mi Youn Park, and Jai Il Youn. "Exacerbation of infliximab-induced paradoxical psoriasis after ustekinumab therapy." Journal of Dermatology 45, no. 3 (March 11, 2017): 332–33. http://dx.doi.org/10.1111/1346-8138.13803.

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29

Denadai, Rafael, Fábio Vieira Teixeira, and Rogério Saad-Hossne. "The onset of psoriasis during the treatment of inflammatory bowel diseases with infliximab: should biological therapy be suspended?" Arquivos de Gastroenterologia 49, no. 2 (June 2012): 172–76. http://dx.doi.org/10.1590/s0004-28032012000200014.

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CONTEXT: Several paradoxical cases of infliximab-induced or-exacerbated psoriatic lesions have been described in the recent years. There is disagreement regarding the need to discontinue infliximab in order to achieve the resolution of these adverse cutaneous reactions specifically in inflammatory bowel disease (IBD) patients. OBJECTIVE: To systematically review the literature to collect information on IBD patients that showed this adverse cutaneous reaction, focusing mainly on the therapeutic approach. METHODS: A systematic literature review was performed utilizing Medline, Embase, SciELO and Lilacs databases. Published studies were identified, reviewed and the data were extracted. RESULTS: Thirty-four studies (69 IBD patients) met inclusion criteria for review. There was inconsistency in reporting of some clinical and therapeutic aspects. Most patients included had Crohn's disease (89.86%), was female (47.83%), had an average age of 27.11 years, and no reported history of psoriasis (84.05%). The patients developed primarily plaque-type psoriasis (40.58%). There was complete remission of psoriatic lesions in 86.96% of IBD patients, existing differences in the therapeutic approaches; cessation of infliximab therapy led to resolution in 47.83% of cases and 43.48% of patients were able to continue infliximab therapy. CONCLUSION: As increasing numbers of IBD patients with psoriasis induced or exacerbated by infliximab, physicians should be aware of its clinical manifestations so that appropriate diagnosis and treatment are properly established. The decision whether to continue or discontinue infliximab should be individualized.

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Mendes Roncada, Eduardo V., Victoria Romanini Brambilla, Beatriz Freitas Filitto, Mariana Pirajá Genta, and Marilda Ap M. Morgado de Abreu. "Atopic Dermatitis as a Paradoxical Effect of Secukinumab for the Treatment of Psoriasis." Case Reports in Dermatology 13, no. 2 (July 9, 2021): 336–39. http://dx.doi.org/10.1159/000513467.

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In the therapeutic arsenal to treat moderate to severe psoriasis, the new agents are secukinumab and ustekinumab, which are fully human monoclonal antibodies, directed against IL-17A and IL-12/23, respectively, which have been shown to be effective and safe in several studies. Their side effects are rare, and the most frequently reported side effects were infection, especially nasopharyngitis, headache, pruritus, high blood pressure, and low back pain. Unlike the side effects, the paradoxical reaction can be defined by the appearance or exacerbation of a pathological condition that usually responds to a certain class of drug. The appearance of this reaction in patients using anti-interleukins is poorly described; however, as they are new drugs, they may be more common than the literature reports. We describe a case of a paradoxical reaction, with the appearance of atopic dermatitis, after using secukinumab to treat psoriasis.

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31

Brugnera Nunes de Mattos, Alexandra, Mariane Maria Cerneski, Sheila Reichert, and Cassia Nava Jaeger. "Use of Adalimumab, a TNF-Alpha Inhibitor, is Associated with Paradoxical Psoriasis: Two Clinical Case Reports." Brazilian Journal of Case Reports 3, no. 2 (January 27, 2023): 12–15. http://dx.doi.org/10.52600/2763-583x.bjcr.2023.3.2.12-15.

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The use of tumor necrosis factor (anti-TNF) antagonists has become a practice applied in the treatment of various inflammatory diseases, such as psoriasis. However, the use of Anti-TNF can, paradoxically, trigger side effects as a form of psoriasiform or worsening of pre-existing symptoms, in patients with or without previously diagnosed psoriasis. In view of this, two case reports were described. First, we described a 21-year-old female patient who used adalimumab for four months due to extensive suppurative hidradenitis. In the second case, we related a 32-year-old male patient diagnosed with severe Crohn's disease, with Adalimumab for three months developed psoriasis.

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Nnodum, Benedicta Nneoma, Lida P. Hariri, Despoina Mavrommati, and Lauren Dudley. "A Case of Severe Symptomatic Central Nervous System Sarcoidosis Secondary to Treatment with Adalimumab." Case Reports in Rheumatology 2019 (June 16, 2019): 1–6. http://dx.doi.org/10.1155/2019/7121539.

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Antitumor necrosis factor-α therapy has been used effectively in treatment of many inflammatory diseases such as rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel disease. There are increasing number of paradoxical reactions associated with this therapy that are being reported. We present the case of a 63-year-old male with psoriatic arthritis maintained on adalimumab and methotrexate (previous treatment trials of prednisone and leflunomide) who developed severe symptomatic sarcoidosis in the brain, liver, and lung. Upon discontinuation of adalimumab, the symptoms resolved but the imaging findings persisted. Although the development of sarcoidosis (usually in the lung, skin, and eyes) while on antitumor necrosis factor-α therapy is increasingly reported, the brain and liver are less commonly involved but should be borne in mind by physicians when extensive granulomatous lesions develop.

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Hardman-Smart, J., S. Solanky, O. Munir, R. Forughian, I. Tosi, S. K. Mahil, J. Barker, C. Smith, and P. Di Meglio. "056 Dissecting the pathogenesis of anti-TNF-induced paradoxical psoriasis." Journal of Investigative Dermatology 141, no. 10 (October 2021): S158. http://dx.doi.org/10.1016/j.jid.2021.08.058.

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Xia, Ping, Yan-Hong Li, Zhong Liu, Xu Zhang, Qian Jiang, Xiao-Yong Zhou, and Wei Su. "Recalcitrant paradoxical pustular psoriasis induced by infliximab: Two case reports." World Journal of Clinical Cases 9, no. 15 (May 26, 2021): 3655–61. http://dx.doi.org/10.12998/wjcc.v9.i15.3655.

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Nguyen, Douglas, Nneka Comfere, William Sandborn, Edward Loftus, and David Bruining. "Anti-TNF Alpha Drug Induced Pustular Psoriasis - A Paradoxical Reaction." American Journal of Gastroenterology 104 (October 2009): S354. http://dx.doi.org/10.14309/00000434-200910003-00961.

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Shahid, Tamoor, Saad Bin Jamil, Harish Guddati, Kamran Zahid, and Hilary Hertan. "Anti-TNF Alpha-Induced Psoriasis: A Rare Paradoxical Side Effect." American Journal of Gastroenterology 112 (October 2017): S1110—S1111. http://dx.doi.org/10.14309/00000434-201710001-02017.

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Croitoru, D. O., L. Eder, S. Cachetaux, S. Brooks, N. Nathanielsz, S. Afiuni, A. Krizova, J. Limacher, H. Jackson, and V. Piguet. "395 Defining Paradoxical Psoriasis and Deep Tissue Immune Cell Profiling." Journal of Investigative Dermatology 142, no. 12 (December 2022): S248. http://dx.doi.org/10.1016/j.jid.2022.09.408.

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Cottone, Mario, Chiara Sapienza, Fabio Salvatore Macaluso, and Marco Cannizzaro. "Psoriasis and Inflammatory Bowel Disease." Digestive Diseases 37, no. 6 (2019): 451–57. http://dx.doi.org/10.1159/000500116.

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Background: Inflammatory bowel disease (IBD) and psoriasis (PS) are associated conditions. The reason for this association lies in the sharing of predisposition genes and common immunological mechanisms. Summary: This review will focus on the interplay between IBD and PS, with details on prevalence and phenotype of PS in IBD, genetics, pathogenetic pathways, and therapy. Key Messages: Microbiome seems relevant in both conditions: a reduction of beneficial bacteria has been observed. IBD and PS have in common some comorbidities like cardiovascular disease, similar risk of cancer and psychiatric problems. Many biological therapies such as anti-tumour necrosis factor (TNF) and anti-interleukin 23 are effective in both conditions, underlining the common immunological mechanisms. Paradoxical PS has been mainly observed after anti-TNF therapies, but preliminary reports show that it can also occur with other biologics. Genetic predisposition to this phenomenon has been reported.

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Zangrilli, Arianna, Mauro Bavetta, Sara Mazzilli, Virginia Garofalo, and Luca Bianchi. "Paradoxical case effects of psoriasis following adalimumab therapy: A case series." Dermatologic Therapy 31, no. 6 (September 21, 2018): e12729. http://dx.doi.org/10.1111/dth.12729.

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Vidal, D., S. Ros, and D. Reina. "Paradoxical Arthritis Due to Ixekizumab in a Patient With Plaque Psoriasis." Actas Dermo-Sifiliográficas (English Edition) 110, no. 3 (April 2019): 255–56. http://dx.doi.org/10.1016/j.adengl.2017.12.025.

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Bataille, P., A. Masson, M. Vignon-Pennamen, J. Bouaziz, and J. Gornet. "Possible Paradoxical Photosensitive Psoriasis Induced by Tumour Necrosis Factor-alpha Inhibitors." Acta Dermato Venereologica 99, no. 13 (2019): 1293–94. http://dx.doi.org/10.2340/00015555-3330.

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THOMAS, LAURE, FLORENCE CANOUI-POITRINE, JACQUES-ERIC GOTTENBERG, ANDRA ECONOMU-DUBOSC, FATIHA MEDKOUR, XAVIER CHEVALIER, SYLVIE BASTUJI-GARIN, HERVÉ LE LOUËT, VALÉRIE FARRENQ, and PASCAL CLAUDEPIERRE. "Incidence of New-onset and Flare of Preexisting Psoriasis During Rituximab Therapy for Rheumatoid Arthritis: Data from the French AIR Registry." Journal of Rheumatology 39, no. 5 (April 15, 2012): 893–98. http://dx.doi.org/10.3899/jrheum.111347.

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Objective.Psoriasis could be a paradoxical reaction to tumor necrosis factor-α antagonist therapy and it has been reported with rituximab therapy. Our objective was to assess the rates of new-onset and flare of preexisting psoriasis in patients taking rituximab for rheumatoid arthritis (RA).Methods.The nationwide multicenter prospective AutoImmunity and Rituximab (AIR) registry was set up in 2006 by the French Society for Rheumatology to collect data on patients taking rituximab for joint diseases. We identified patients with RA in the registry who had psoriasis listed as an adverse drug reaction, and we obtained additional information from their physicians if needed. We computed the incidence rates of new-onset and flare of preexisting psoriasis according to the rituximab exposure time.Results.Among the 1927 patients in the registry with RA, 2 had new-onset and 5 had flare of preexisting psoriasis after a median followup of 39.2 weeks. Incidence rates were 1.04/1000 person-years (95% CI 0.13 to 3.8) for new-onset psoriasis and 2.6/1000 person-years (95% CI 0.84 to 6.1) for flare of preexisting psoriasis. Rituximab rechallenge in the 2 new-onset cases and in 2 flare cases was not followed by recurrence or exacerbation of psoriasis. Two of the 5 flare cases developed after discontinuation of methotrexate.Conclusion.Despite the small number of cases observed, leading to wide CI, the incidence rates in our study do not support a causative role of rituximab therapy in new-onset or flare of preexisting psoriasis in patients with RA.

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Alinaghi, Farzad, Hasan Göcker Tekin, Johan Burisch, Jashin J. Wu, Jacob P. Thyssen, and Alexander Egeberg. "Global Prevalence and Bidirectional Association Between Psoriasis and Inflammatory Bowel Disease—A Systematic Review and Meta-analysis." Journal of Crohn's and Colitis 14, no. 3 (August 30, 2019): 351–60. http://dx.doi.org/10.1093/ecco-jcc/jjz152.

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Abstract Background and Aims Epidemiological studies have established an association between psoriasis and inflammatory bowel disease [IBD], i.e. ulcerative colitis [UC] and Crohn’s disease [CD], but results are inconsistent. The aim of this study was therefore to quantify the prevalences and association between IBD and psoriasis. Methods PubMed, Web of Science, and EMBASE were searched from database inception through April 2018 for studies reporting data on psoriasis among patients with IBD and vice versa. Meta-analysis was performed to estimate, respectively, the prevalences and association between IBD and psoriasis. Data extraction was according to the PRISMA guideline, and quality assessment was made using the Newcastle-Ottawa Scale. The main outcomes were the proportion of psoriasis patients with IBD and vice versa, as well as the association (odds ratio [OR]) of IBD in psoriasis and psoriasis in IBD, respectively. Results Based on quantitative analysis of 93 studies, the prevalence of psoriasis in CD and in UC was 3.6% (95% confidence interval [CI] 3.1%–4.6%) and 2.8% [95% CI 2.0%–3.8%] respectively. The prevalence of CD and UC was 0.7% [95% CI 0.2%–1.3%] and 0.5% [95% CI 0.3%–0.8%], respectively, among patients with psoriasis. Presence of CD or UC was significantly associated with psoriasis, with OR 2.0 [95% CI 1.4–2.9] and OR 1.5 [95% CI 1.2–2.0], respectively. Presence of psoriasis was significantly associated with CD: OR 2.2 [95% CI 1.6–3.1] and with UC: OR 1.6 [95% CI 1.3–2.0]. Conclusions We found significant bidirectional associations between psoriasis and IBD, warranting increased awareness among clinicians in the diagnostic process, especially in children and adolescents with IBD. Last, this study showed an increased frequency of paradoxical psoriasis in patients treated with biologics.

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Bose, Reetesh, and Jennifer Beecker. "Dyshidrotic eczema in two patients on secukinumab for plaque psoriasis: A case report." SAGE Open Medical Case Reports 8 (January 2020): 2050313X2090456. http://dx.doi.org/10.1177/2050313x20904561.

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Secukinumab was the first fully human anti-interleukin-17a monoclonal antibody and successfully treated moderate-severe psoriasis. These new, targeted, medications are becoming more ubiquitous, but long-term side effects are not fully known. Post-market surveillance is crucial to identify delayed adverse events, analogous to the paradoxical development of pustular psoriasis in a subset of patients treated with the anti-tumor necrosis factor-alpha class drugs. Dyshidrotic eczema and pompholyx are rare variants of dermatitis characterized by vesicles or bullae on the palms, soles and sides of the fingers. The etiology of dyshidrotic eczema is not always known, but medications have been implicated in a minority of patients. Herein, we present two cases of dyshidrotic eczema developing in patients on secukinumab for psoriasis. Extended follow-up and larger numbers of patients are needed to fully understand the potential association between secukinumab and dyshidrotic eczema.

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Nair, Laxmi V. "Management of recalcitrant palmoplantar psoriasis." Journal of Skin and Sexually Transmitted Diseases 1 (April 22, 2019): 8–12. http://dx.doi.org/10.25259/jsstd_15_2019.

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Management of recalcitrant palmoplantar psoriasis and palmoplantar pustular psoriasis continues to be a challenge. Standardized therapeutic guidelines are not available due to limited data. The recalcitrant nature points to the need for systemic therapy but a trial with topical therapy is needed before planning systemic therapy. Among the topical therapies available topical steroids or combination of topical steroids with calcipotriol are the most effective. Light-based therapies are effective modalities in patients who do not respond to topical therapy. Systemic therapy is indicated in non-responders. Acitretin, methotrexate and cyclosporine are widely used. There are increasing data on the use of biologicals in non-responders to systemic immunomodulators, but the cost is a deterrent. The biologic agents include etanercept, infliximab, adalimumab, ustekinumab, secukinumab, apremilast and others. Traditional therapies such as phototherapy, acitretin or methotrexate are often preferred over newer antitumor necrosis factor (TNF) agents for patients with comorbid conditions due to the immunosuppressive effects of TNF-α inhibitors and concern about paradoxical exacerbation of disease in some patients.

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Fania, Luca, Martina Morelli, Claudia Scarponi, Laura Mercurio, Fernanda Scopelliti, Caterina Cattani, Giovanni Luca Scaglione, et al. "Paradoxical psoriasis induced by TNF‐α blockade shows immunological features typical of the early phase of psoriasis development." Journal of Pathology: Clinical Research 6, no. 1 (October 29, 2019): 55–68. http://dx.doi.org/10.1002/cjp2.147.

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Alcorta Lorenzo, N., A. De Diego Sola, J. A. Valero Jaimes, C. A. Egües, J. J. Cancio Fanlo, L. M. Lopez Dominguez, O. Maiz-Alonso, J. M. Belzunegui Otano, and E. Uriarte Isacelaya. "AB1205 PARADOXICAL BIOLOGICS-INDUCED AUTOIMMUNE DISEASES." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1893.2–1894. http://dx.doi.org/10.1136/annrheumdis-2020-eular.5876.

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Background:Biological therapies have revolutionized the management of rheumatic diseases. This study analyzes the paradoxical autoimmune inflammatory manifestations that these therapies can induce. They are described as paradoxical because these are diseases in which the same biological drugs have proven effective.Objectives:The aim of this study is to carry out a descriptive analysis of paradoxical biologics-induced autoimmune manifestations.Methods:A retrospective research was carried out during January 2017 and March 2018 at Hospital Universitario Donostia.Computerized medical records were reviewed. The following variables were recorded: underlying disease; type of developed manifestation; the triggering biologic drug and its duration; concomitant treatment with disease-modifying antirheumatic drugs (DMARDs), previous biological treatments; the adopted measure and the resolution of the complication or not.Qualitative variables are recorded in absolute value and in percentage. The quantitative variables are recorded with the mean and standard deviation. The data has been analyzed with the SPSS Statistics 20 program.Results:Twenty-six cases were analyzed. The most common triggering drugs were infliximab (30.8%), adalimumab (30.8%) and etanercept (15.4%). The most common underlying diseases were spondyloarthritis (42.3%), rheumathoid arthritis (34.6%) and Crohn’s disease (11.5%). The most developed complications were cutaneous affectations (76.9%), psoriasis specifically.Statistical significative difference regarding the molecules causing the complication, has only been found in the previous use of biologic drugs (p 0.003), number of treatment dropouts (p 0.048) and number of resolved complications (regardless of the adopted measure) (p 0.041).Conclusion:Infliximab and adalimumab are the drugs that presented the most paradoxical manifestations, probably because they are the oldest and most used ones. The difference found in previously used biologics, could be due to the fact that new drugs are less frequently presented as the first option. Psoriasis is the most frequently developed complication. The difference found in the number of abandonments of the biologic treatment and the solution of the complication might be more associated with the complication itself, rather than with the responsible molecule. There is no consensus on the measures to be taken when facing the complication. The severity of the manifestation should be assessed, as well as the control of the underlying disease. Most complications resolve overtime.Table 1Infliximabn 8 (31.8%)Adalimumabn 8 (30.8%)Etanerceptn 4 (15.4%)Certolizumabn 2 (7.7%)Golimumabn 2 (7.7%)Abataceptn 1 (3.8%)Tocilizumabn 1 (3.8%)Totaln 26 (100.0%)p valueUnderlying disease0.789Rheumatic (%)6 (75.0)5 (62.5)4 (100.0)2 (100.0)2 (100.0)1 (100.0)1 (100.0)21 (80.0)Digestive (%)2 (25.0)3 (37.5)000005 (19.2)Type of developed manifestation0.235Hematologic (%)01 (12.5)000001 (3.8)Neurologic (%)2 (25.0)0000002 (7.7)Digestive (%)00001 (50.0)001 (3.8)Cutaneous (%)6 (75.0)6 (75.0)4 (100.0)2 (100.0)1 (50.0)01 (100.0)20 (76.9)Other (%)01 (12.5)0001 (100.0)02 (7.7)Table 2Infliximabn 8Adalimumabn 8Etanerceptn 4Certolizumabn 2Golimumabn 2Abataceptn 1Tocilizumabn 1Totaln 2p valueThe triggering biologic drug and its duration (months)43.25(SD 44.81)10.9375.50(SD 66.08)4.5011.006.005.0030.660.635Concomitant treatment with DMARDs (%)2 (25.0)2 (25.0)1 (25.0)1 (50.0)001 (100.0)7 (26.9)0.811Previous biological treatment (%)02 (25.0)1 (25.0)2 (100.0)2 (100.0)1 (100.0)1 (100.0)9 (34.6)0.003Suspension as the adopted measure (%)5 (62.5)7 (87.5)02 (100.0)1 (50.0)1 (100.0)1 (100.0)17 (65.4)0.048Resolution of the complication (%)3 (37.5)8 (100.0)1 (25.0)1 (50.0)1 (50.0)1 (100.0)1 (100.0)16 (64.0)0.041Disclosure of Interests:None declared

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Rosenwasser, Natalie, Dale Lee, Robert Sidbury, and Yongdong Zhao. "Paradoxical Psoriasis in Children Receiving Anti-TNFα Treatment for Inflammatory/autoimmune Disease." Pediatric Drugs 23, no. 2 (March 2021): 131–41. http://dx.doi.org/10.1007/s40272-021-00440-8.

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Courbette, Olivier, Camille Aupiais, Jerome Viala, Jean-Pierre Hugot, Baptiste Louveau, Lucienne Chatenoud, Emmanuelle Bourrat, and Christine Martinez-Vinson. "Infliximab Paradoxical Psoriasis in a Cohort of Children With Inflammatory Bowel Disease." Journal of Pediatric Gastroenterology and Nutrition 69, no. 2 (August 2019): 189–93. http://dx.doi.org/10.1097/mpg.0000000000002349.

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Munera-Campos, M., F. Ballesca, and J. M. Carrascosa. "Paradoxical Reactions to Biologic Therapy in Psoriasis: A Review of the Literature." Actas Dermo-Sifiliográficas (English Edition) 109, no. 9 (November 2018): 791–800. http://dx.doi.org/10.1016/j.adengl.2018.09.012.

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