Xia P, Li YH, Liu Z, Zhang X, Jiang Q, Zhou XY, Su W. Recalcitrant paradoxical pustular psoriasis induced by infliximab: Two case reports. World J Clin Cases 2021; 9(15): 3655-3661 [PMID: 34046466 DOI: 10.12998/wjcc.v9.i15.3655]
Corresponding Author of This Article
Xiao-Yong Zhou, MD, Doctor, Department of Dermatology, The First Hospital of Wuhan, No. 215 Zhongshan Avenue, Wuhan 430022, Hubei Province, China. zhouxuefeng1970@126.com
Research Domain of This Article
Dermatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ping Xia, Yan-Hong Li, Zhong Liu, Xu Zhang, Qian Jiang, Xiao-Yong Zhou, Department of Dermatology, The First Hospital of Wuhan, Wuhan 430022, Hubei Province, China
Wei Su, Department of Dermatology, Midwest Center for Dermatology and Cosmetic Surgery, Clinton Township, MI 48038, United States
Author contributions: Xia P performed the literature search, clinical studies and wrote the manuscript; Li YH, Liu Z, Zhang X, and Jiang Q did laboratory tests and data analysis; Zhou XY contributed the concept, design, and manuscript editing; Su W reviewed and edited the manuscript; All authors have read and approve the final manuscript.
Supported bythe Ministry of Science and Technology of China, No. 2018YFC1705304 and Hubei Natural Science Foundation, No. 2020CFB503.
Informed consent statement: All participants provided written informed consent.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Yong Zhou, MD, Doctor, Department of Dermatology, The First Hospital of Wuhan, No. 215 Zhongshan Avenue, Wuhan 430022, Hubei Province, China. zhouxuefeng1970@126.com
Received: November 4, 2020 Peer-review started: November 4, 2020 First decision: February 12, 2021 Revised: February 25, 2021 Accepted: March 12, 2021 Article in press: March 12, 2021 Published online: May 26, 2021 Processing time: 188 Days and 9.1 Hours
Abstract
BACKGROUND
Paradoxical psoriasis induced by tumor necrosis factor alpha antagonists is a rare side effect of those drugs and has similarities with and differences from classical psoriasis in clinical and pathological characteristics. Treating severe paradoxical psoriasis is challenging because the reported cases are rare, with treatment experience being only anecdotal.
CASE SUMMARY
We report 2 cases of paradoxical psoriasis caused by infliximab. Both cases manifested with a significant number of pustular lesions and had protracted and complicated clinical courses. In case 1, secukinumab alone could not control the eruptions, but colchicine supplementation markedly decreased disease activity. In case 2 miscellaneous medications were administered, including the systemic drug acitretin, the immunosuppressive drug cyclosporine, and the biologic agent ustekinumab. However, multiple applications of those medications failed to prevent new lesions from occurring. Both cases showed moderate-to-high anti-nuclear antibody titers.
CONCLUSION
Based on these cases, moderate-to-high anti-nuclear antibody titer seems to be a risk factor for paradoxical psoriasis. In addition, extensive pustular presentation may be a negative prognostic indicator and may portend a protracted clinical course refractory to therapy.
Core Tip: In this study, we report 2 cases of paradoxical psoriasis caused by infliximab. The data indicated that moderate-to-high anti-nuclear antibody titer was a risk factor for paradoxical psoriasis. In addition, extensive pustular presentation might be a negative prognostic indicator and portends a protracted clinical course refractory to therapy.
