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- Title
Psoriasiform Dermatitis Developing during Treatment of Juvenile Idiopathic Arthritis with Tocilizumab.
- Authors
Matsushima, Yoshiaki; Hayashi, Akinobu; Mizutani, Kento; Kondo, Makoto; Nakai, Yasuo; Habe, Koji; Yamaguchi, Yukie; Kozuka, Yuji; Wakabayashi, Hiroki; Yamanaka, Keiichi
- Abstract
We present a case of psoriasiform dermatitis developing during the treatment of juvenile idiopathic arthritis with tocilizumab (TCZ). The keratotic erythema with central healing showed a periodicity of growing worse 1 week after TCZ infusion, and then disappeared within 3 weeks. Skin biopsy showed parakeratosis, microabscess, rete ridge elongation, and abundant lymphocytes as well as a few neutrophil infiltrate in the upper dermis. TCZ is a humanized monoclonal antibody against interleukin 6 (IL-6) receptor. IL-6 plays a critical role in the differentiation from naïve T cells into Th17 cells in cooperation with transforming growth factor-β. IL-6 may be important in psoriasis pathogenesis, and therefore this phenomenon may be the adverse effect. The mechanism of TCZ-associated psoriasiform dermatitis is unclear. The serum IL-6 level seems to be elevated transitorily after TCZ administration, probably due to the competitive inhibition of IL-6 receptor alpha to IL-6. Excess free IL-6 may effect on other IL-6 family receptors. Since TCZ does not alter serum IL-17F level, another cytokine may be involved in the psoriasis formation in our case. Psoriasiform dermatitis during the use of TCZ may be due to relative cytokine balance disturbance.
- Subjects
JUVENILE idiopathic arthritis; T helper cells; MACROPHAGE activation syndrome; SKIN inflammation; TOCILIZUMAB; PATHOLOGY
- Publication
Case Reports in Dermatology, 2019, Vol 11, Issue 3, p317
- ISSN
1662-6567
- Publication type
Article
- DOI
10.1159/000504429