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Paradoxical psoriasis induced by IL-17 antagonists
Yachen Wang1, Fengling Yang1, Ruizhe Wang1
1Department of Dermatology, Tianjin Medical University General Hospital, Anshan Dao, Tianjin, China.
Indian Journal of Dermatology, Venereology and Leprology
|April 10, 2024
Summary
Paradoxical psoriasis can occur when using Interleukin-17 (IL-17) inhibitors, often worsening symptoms. Treatment requires different strategies than those for Tumour Necrosis Factor alpha (TNF-α) inhibitors, and reintroducing IL-17 inhibitors is not recommended.
Area of Science:
- Dermatology
- Immunology
- Pharmacology
Background:
- Interleukin-17 (IL-17) inhibitors can paradoxically trigger psoriasis.
- This phenomenon presents a significant therapeutic challenge for patient management.
- Understanding the mechanisms is crucial for effective treatment strategies.
Purpose of the Study:
- To document clinical cases of IL-17 inhibitor-induced psoriasis.
- To conduct a comprehensive literature review of existing cases.
- To elucidate the likely mechanisms driving this adverse effect.
Main Methods:
- Systematic literature review of published case reports and series.
- Analysis of clinical presentation and treatment outcomes.
- Hypothesizing the underlying immunological pathways.
Main Results:
- 30 cases of IL-17 inhibitor-induced paradoxical psoriasis identified across 22 articles.
- Most cases occurred in patients with a prior history of psoriasis.
- Morphological changes (plaque, pustular) were common; 73.3% required drug discontinuation for symptom resolution.
Conclusions:
- Paradoxical psoriasis from IL-17 inhibitors necessitates distinct treatment approaches compared to TNF-α inhibitor-induced psoriasis.
- Re-challenge with IL-17 inhibitors is generally ineffective.
- Proposed mechanism involves IL-17 inhibition leading to TNF-α downregulation, subsequently upregulating plasmacytoid dendritic cells and IFN-α production.
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