Развитие псориаза на фоне терапии ингибитором интерлейкина 17 у больных анкилозирующим спондилитом: описание случаев и обзор литературы

Парадоксальный псориаз (пПсО) – обострение или развитие de novo псориаза (ПсО) при лечении препаратами, которые должны его купировать. Он наблюдается приблизительно у 5% пациентов, получавших ингибиторы фактора некроза опухоли α и реже – ингибиторы интерлейкина (иИЛ) 17. К настоящему времени описано несколько десятков случаев пПсО при применении иИЛ17 у пациентов с ПсО и единичные – у больных анкилозирующим спондилитом (АС).

Мы наблюдали 2 пациентов (мужчину и женщину) с АС, у которых на фоне терапии тремя разными иИЛ17: секукинумабом (СЕК), нетакимабом (НТК) и иксекизумабом (ИКСЕ) возникло три эпизода пПсО. В одном случае обычный бляшечный ПсО развился при применении СЕК, в другом – ладонно-подошвенный пустулез появился через 1 мес после первого введения НТК и регрессировал после его отмены. Повторное обострение наблюдалось через 2 года на фоне лечения ИКСЕ. Представлено морфологическое описание биоптата кожи.

В статье обсуждаются частота, вероятные причины развития и пути преодоления пПсО.

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