IL-17A抑制剂治疗乌司奴单抗诱发的脓疱型银屑病1例  

A case of ustekinumab-induced pustular psoriasis was treated with IL-17A inhibitor

作　　者：林俊杰 欧敏 李阳 佘昕妍 蔡丽婷 关则璞 王晓华 LIN Junjie;OU Min;LI Yang;SHE Xinyan;CAI Liting;GUAN Zepu;WANG Xiaohua(Dermatology Hospital,Southern Medical University,Guangzhou 510091,China;Huizhou Dermatology Hospital,Huizhou 516008,China)

机构地区：[1]南方医科大学皮肤病医院,广东广州510091 [2]惠州市皮肤病医院,广东惠州516008

出　　处：《皮肤性病诊疗学杂志》2024年第11期778-782,共5页Journal of Diagnosis and Therapy on Dermato-venereology

摘　　要：报告1例IL-17A抑制剂治疗乌司奴单抗诱发的脓疱型银屑病。患者女,51岁,因全身红斑块、鳞屑20年,加重伴脓疱10余天就诊。患者既往确诊斑块型银屑病,系统药物控制不佳,排除相关禁忌症后,予45 mg乌司奴单抗皮下注射治疗,期间患者全身皮疹消退,但完成4次治疗后全身出现红斑、鳞屑并伴有脓疱。皮肤科检查:头面部可见散在红色斑块,银白色鳞屑,可见薄膜现象,Auspitz征(+)。躯干和四肢散在大片红斑、红斑块,其上密集粟粒大小脓疱,局部脓疱中央颜色为褐色,呈现靶形损害,部分脓疱融合成脓湖。外阴粘膜散在脓疱、糜烂面。十指指甲顶针样改变,甲板肥厚改变。皮损组织病理检查:角化过度,融合性角化不全,颗粒层变薄或消失,表皮银屑病样增生,见Munro和Kogoj微脓疡,真皮乳头水肿,血管扩张,血管周围淋巴细胞浸润。诊断:脓疱型银屑病。治疗:局部外用皮质类固醇及注射160 mg依奇珠单抗,3 d内皮疹消退。之后按说明书注射依奇珠单抗,随访1年无新发皮疹。We report a case of ustekinumab-induced pustular psoriasis treated with IL-17A inhibitor.A 51-year-old female presented with red plaques and scales for 20 years,with aggravation and pustules for over 10 days.The patient was previously diagnosed with plaque psoriasis,and poorly responded to systemic medications.After ruling out contraindications,the patient was subcutaneously given 45 mg of ustekinumab,resulting in clearance of the skin lesion.But erythema and scales with pustules appeared all over the body after the fourth treatment.Physical examination revealed scattered red plaques covered with white-silver scales,and Auspitz sign(+)on the head and face.The trunk and limbs were scattered with large erythematous patches and erythematous plaques,covered with various size of dense pustules,in a target-shape with a brown center.Some pustules merged to pus-lake.Pustules with erosive surface were scattered on the vulvar mucosa.Nails appeared thimble-like with nail plate thickening.Histopathology showed hyperkeratosis,parakeratosis,thinning or disappearance of granular layer,psoriasis-like epidermal hyperplasia,Munro and Kogoj microabscesses,papillary dermal edema,vascular dilation,and perivascular lymphocytic infiltration.Diagnosis was pustular psoriasis.After the treatment with topical corticosteroids and 160 mg of ixekizumab,the rashes subsided within 3 days.Afterwards,patient was treated with ixekizumab according to the manufacturer′s instruction,without the development of new lesion during 1-year follow-up.

关 键 词：脓疱型银屑病 药疹 乌司奴单抗 IL-12 IL-23 依奇珠单抗 

分 类 号：R758.63[医药卫生—皮肤病学与性病学]