Hidradenitis suppurativa (HS): An unrecognized paradoxical effect of biologic agents (BA) used in chronic inflammatory diseases

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• 作者：Coline Faivre ; MD^a ; ^{coline.faivre@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Axel Patrice Villani ; MD^a ; Franç ; ois Aubin ; MD ; PhD^h ; Dan Lipsker ; MD ; PhD^b ; Martine Bottaro ; MD^j ; Jean-David Cohen ; MD^l ; Franç ; ois Durupt ; MD ; PhD^k ; Gé ; raldine Jeudy ; MD^c ; Emilie Sbidian ; MD ; PhD^d ; Eric Toussirot ; MD ; PhDⁱ ; Valé ; rie Badot ; MD ; PhD^m ; Sé ; bastien Barbarot ; MD ; PhD^e ; Sé ; bastien Debarbieux ; MD^f ; Emmanuel Delaporte ; MD ; PhD^g ; Guetty Goegebeur ; MDⁿ ; Jacques Morel ; MD ; PhD^o ; Aude Nassif ; MD^p ; Gé ; rard Duru ; PhD^a ; Denis Jullien ; MD ; PhD^a ; on behalf of the French Society of Dermatology ; Club Rheumatisms ; Inflammation
• 关键词：biologic agents ; hidradenitis suppurativa ; paradoxical reactions ; tumor necrosis factor-alfa inhibitors
• 刊名：Journal of the American Academy of Dermatology
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：74
• 期：6
• 页码：1153-1159
• 全文大小：338 K

文摘

Paradoxical hidradenitis suppurativa (HS) induced by biologic agents (BA) is scarcely reported.

Objective

We sought to describe the clinical characteristics and outcome of patients developing paradoxical HS under BA.

Methods

This was a multicenter nationwide retrospective study asking physicians to report all cases of HS, confirmed by a dermatologist, occurring during treatment of an inflammatory disease by a BA.

Results

We included 25 patients (15 inflammatory rheumatism, 9 Crohn's disease, 1 psoriasis) treated by 5 BA (adalimumab = 12, infliximab = 6, etanercept = 4, rituximab = 2, tocilizumab = 1). Median duration of BA exposure before HS onset was 12 (range 1-120) months. Patients were mostly Hurley stage I (n = 13) or II (n = 11). Simultaneously to HS or within 1 year, 11 patients developed additional inflammatory diseases, including paradoxical reactions (psoriasis = 9, Crohn's disease = 3, alopecia areata = 1, erythema elevatum diutinum = 1). Complete improvement of HS was more frequently obtained after BA discontinuation or switch (n = 6/10, 60%) rather than maintenance (n = 1/14, 7%). Reintroducing the same BA resulted in HS relapse in 3 of 3 patients.

Limitations

Retrospective nature and lack of complete follow-up for some patients are limitations.

Conclusion

HS is a rare paradoxical adverse effect of BA, but fortuitous association cannot be excluded in some cases. We observed a trend toward better outcome when the BA was discontinued or switched.