Artikel
Paradoxical palmoplantar pustulosis induced by secukinumab and brodalumab – report on 3 cases
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Veröffentlicht: | 8. Oktober 2019 |
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Gliederung
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Paradoxical adverse drug reactions are defined as manifestation or unexpected exacerbation of a disease that is known to respond to that drug. The most commonly observed paradoxical drug reaction to TNF-blockers is a psoriasiform dermatitis, with pustular variants accounting for 4% to 56% of these cases. Under therapy of IL17A- or IL17RA-blockers, manifestation of pustular variants of psoriasis have only been reported in two cases, both during therapy with secukinumab. Here, we report 3 cases of new-onset palmoplantar pustulosis in patients treated for psoriatic arthritis or plaque psoriasis, one occurring under brodalumab and two under secukinumab therapy. In one patient, lesions resolved after discontinuation of the IL17A blocker, in the second patient pustular lesions resolved after switching brodalumab to ustekinumab, while in the third patient, palmoplantar pustulosis persisted for at least 6 weeks after switching the IL17A blocker to ustekinumab. Possibly, paradoxical pustular reactions also play a role in therapy with IL17A/IL17RA blockers, and their pathomechanism remains to be investigated.