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. 2022 May;47(5):918-925.
doi: 10.1111/ced.15052. Epub 2022 Feb 9.

Eczematous drug eruption in patients with psoriasis under anti-interleukin-17A: does interleukin-22 play a key role?

Matteo Megna  1 , Giuseppina Caiazzo  1 , Melania Parisi  1 , Angelo Ruggiero  1 , Gianmarco Capasso  1 , Massimo Mascolo  2 , Daniela Russo  2 , Lucia Gallo  1 , Gabriella Fabbrocini  1 , Maddalena Napolitano  3 , Cataldo Patruno  4
Affiliations

Eczematous drug eruption in patients with psoriasis under anti-interleukin-17A: does interleukin-22 play a key role?

Matteo Megna et al. Clin Exp Dermatol. 2022 May.

Abstract

Background: Eczematous drug eruption (EDE) is a spongiotic skin reaction in response to systemic medications. To date, EDE has been described in patients treated with anti-interleukin (IL)-17A monoclonal antibodies with a prevalence of 2.2%-12.1%.

Aim: To describe the clinical and histological features and the skin cytokine milieu in patients with EDE induced by anti-IL-17A biologics.

Methods: This was a prospective study, enrolling patients with psoriasis who developed EDE during treatment with two anti-IL-17 biologics, ixekizumab and secukinumab, from June 2019 to April 2021. Skin biopsies were taken from all patients: a 5-mm lesional biopsy (LB) and a 3-mm nonlesional biopsy (NLB). The LB sample was split into two parts, one for histological examination and the other for cytokine profile evaluation.

Results: During the study period, treatment with an anti-IL-17A drug was given to 289 patients of whom 8 (2.8%) developed EDE during the treatment. Histopathological evaluation suggested a diagnosis of spongiotic dermatitis in all eight patients. Cytokine gene expression showed a predominance of T helper (Th)2/Th22 cytokines in EDE lesions with a large increase in IL-4, IL-22 and S100A7 levels in both LB and NLB samples compared with healthy skin. IL-4, IL-22 and S100A7 were significantly higher in LB compared with NLB samples. IL-26 levels were also significantly increased in both LB and NLB compared with healthy skin, whereas low levels of IL-23A were found in both LB and NLB.

Conclusion: Eczematous drug eruption skin lesions have mainly Th2/Th22 features, with IL-22 playing a major role in their pathogenesis. EDE seems to be the result of an imbalance towards a Th2/Th22 response, secondary to the blockade of IL-17A activity.

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References

    1. Blum AE, Burgin S. Eczematous drug eruptions. Am J Clin Dermatol 2021; 22: 349-66.
    1. Apaydin R, Dökmeci Ş, Bayramgürler D, Yildirim G. Drug eruptions: a study including all inpatients and outpatients at a dermatology clinic of a university hospital. J Eur Acad Dermatol Venereol 2000; 14: 518-20.
    1. Barbaud A, Reichert-Penetrat S, Tréchot P et al. The use of skin testing in the investigation of cutaneous adverse drug reactions. Br J Dermatol 1998; 139: 49-58.
    1. Pernet C, Guillot B, Bessis D. Eczematous drug eruption after ustekinumab treatment. Arch Dermatol 2012; 148: 959-60.
    1. Borch JE, Andersen KE, Bindslev-Jensen C. The prevalence of acute cutaneous drug reactions in a Scandinavian university hospital. Acta Derm Venereol 2006; 86: 518-22.