Acta Dermato-Venereologica 99-13CompleteContent | Page 24

1291 SHORT COMMUNICATION Atopic Dermatitis-like Eruption Induced by Two Different Biologics in a Patient with Psoriatic Arthritis Fumihito ABE, Shinji MITSUYAMA, Eri NAGAO, Masaaki KIMURA and Tetsuya HIGUCHI Department of Dermatology, Toho University Sakura Medical Center, 564-1 Shimosizu, Sakura, Chiba 285-8741, Japan. E-mail: fumihito. [email protected] Accepted Sep 25, 2019; E-published Sep 25, 2019 Various skin manifestations, such as psoriasiform erup- tion, palmoplantar pustulosis, and lupus-like syndrome, have been reported to be induced by tumour necrosis factor alpha (TNF-α) inhibitors (1). Recently, skin ma- nifestations associated with administration of interleukin (IL)-17 inhibitors have also been reported (2). We report here our experience with a patient with psoriatic arthritis who developed atopic dermatitis-like eruptions caused by the separate administration of 2 types of biologics, infliximab and ixekizumab. CASE REPORT The patient was a 46-year-old man with no history of atopic dermatitis. At approximately 30 years of age, he developed plaque psoriasis and received outpatient treatment at a neighbourhood dermatology clinic. His skin manifestations were stabilized by topical applica- tion of betamethasone butyrate propionate ointment and maxacalcitol ointment. One month before his visit to our department, he experienced severe pain in his wrist and finger joints, causing difficulty writing. He was thus referred to our department. He was diagnosed with psoriatic arthritis, and administration of infliximab was initiated. Several days after the initial administration of infliximab, amelioration of arthralgia and erythema was observed. One week later, he developed generalized erythema and papules on the trunk and extremities (Fig. 1). Erythema with scales was observed on his entire face, and he reported severe pruritus. Skin biopsy from a newly developed erythema on the forearm revealed epidermal spongiosis and lymphocyte perivascular infiltration in the upper dermis (Fig. 2). As pruritus and eczematous eruptions persisted, infliximab was discontinued, fol- lowed by gradual resolution of eruptions. However, as the joint symptoms relapsed, ixekizumab was introdu- ced. One week after the introduction of ixekizumab, the eczematous eruptions relapsed, as was observed after treatment with infliximab. His eosinophil count, which was initially within the normal range, increased (830/ µl; pretreatment level, 126/µl). Serum IgE (560 IU/l; normal < 250 IU/l) and thymus and activation-regulated chemokine (980 pg/ml; normal < 449 pg/ml) levels were also high. As the joint symptoms were relieved, administration of ixekizumab was continued, whereas atopic dermatitis-like eruptions were treated with topical application of steroids and moisturizers, after which they were gradually relieved. Fourteen months after initiation Fig. 1. Clinical pictures. (a) Erythema with scales on the face and back at the time of administration of infliximab. (b) Erythema with scales on the face and back at the time of administration of ixekizumab. Permission from the patient is given to publish these photos. of administration of ixekizumab, the eruptions on the patient’s extremities resolved. However, residual ery­ thema with desquamation was still observed on his face. DISCUSSION It has been reported that of 92 patients with Crohn’s disease or rheumatoid arthritis who were treated with infliximab, 19 developed atopic dermatitis-like eruptions. Of these 19 patients, 16 had atopic predisposition (3). In patients with rheumatoid arthritis treated with other TNF-α inhibitors (i.e. adalimumab and etanercept), ec- zema different from psoriasiform eruptions has also been reported (4). There is also a report of atopic dermatitis- like eruptions in patients treated with infliximab for psoriasis (5). Furthermore, recent reports have indicated cases in which atopic dermatitis-like eruptions occur- This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3321 Acta Derm Venereol 2019; 99: 1291–1292