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Histologic comparison of tumor necrosis factor-? inhibitor–induced psoriasis and psoriasis vulgaris - 19/06/20

Doi : 10.1016/j.jaad.2020.01.006 
Jeffrey Zhu Hu, BS a, Steven D. Billings, MD b, Di Yan, MD c, Anthony Patrick Fernandez, MD, PhD b,
a Case Western Reserve University School of Medicine, Cleveland, Ohio 
b Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, Ohio 
c The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York 

Reprint requests: Anthony Patrick Fernandez, MD, PhD, Cleveland Clinic, 9500 Euclid Ave, A61, Cleveland, OH 44195.Cleveland Clinic9500 Euclid Ave, A61ClevelandOH44195

Abstract

Background

Tumor necrosis factor-α inhibitor (TNFi)–induced psoriasis is a paradoxic reaction characterized by the development of a psoriasiform rash that mimics idiopathic psoriasis subtypes both clinically and histologically. Few studies have investigated the histologic features of TNFi-induced psoriasis skin lesions, and most of these are limited by inclusion of few specimens.

Objective

We aimed to characterize histologic features of TNFi-induced psoriasis and identify histologic differences between TNFi-induced psoriasis and idiopathic psoriasis.

Methods

We characterized 60 biopsy specimens obtained from 47 unique patients at a single tertiary care referral center between 2004 and 2016 who developed TNFi-induced psoriasis, and we compared histologic features to those of 85 biopsy specimens from a control group of 85 patients with idiopathic psoriasis.

Results

The most common histologic reaction pattern in TNFi-induced psoriasis biopsy specimens was psoriasiform (80.0%). Five histologic parameters were significantly different in TNFi-induced psoriasis biopsy specimens compared with idiopathic psoriasis biopsy specimens: at least 3 dermal eosinophils per histologic section, neutrophils in the stratum corneum, neutrophils in the epidermis, papillary plate thinning, and absence of parakeratosis.

Limitations

Inability to exclude lesion selection bias as a potential reason for some significant histologic differences.

Conclusions

This study supports the idea that histologic differences exist between TNFi-induced psoriasis and idiopathic psoriasis may help distinguish between these conditions, especially for dermal eosinophil counts of 3 or greater.

Le texte complet de cet article est disponible en PDF.

Key words : eosinophils, histology, parakeratosis, psoriasis vulgaris, TNF-α inhibitor–induced psoriasis

Abbreviations used : IL, INF, INF-α, pDC, TNF-α, TNFi


Plan


 Funding sources: None.
 Disclosure: Dr Fernandez is an investigator for Pfizer, Corbus, Mallinckrodt, and Novartis Pharmaceuticals and receives personal research support from Mallinckrodt and Novartis; honoraria from AbbVie, UCB, Novartis, and Mallinckrodt for consulting and advisory board participation; and honoraria from AbbVie, Novartis, and Mallinckrodt for teaching and speaking. Mr Hu and Drs Billings and Yan have no conflicts of interest to declare.
 IRB approval status: Reviewed and approved by the Cleveland Clinic IRB (approval #13-701).


© 2020  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 83 - N° 1

P. 71-77 - juillet 2020 Retour au numéro
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