Psoriasiform Dermatitis Developing during Treatment of Juvenile Idiopathic Arthritis with Tocilizumab

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 p...

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Bibliographic Details
Published in:Case reports in dermatology 2019-09, Vol.11 (3), p.317-321
Main Authors: Matsushima, Yoshiaki, Hayashi, Akinobu, Mizutani, Kento, Kondo, Makoto, Nakai, Yasuo, Habe, Koji, Yamaguchi, Yukie, Kozuka, Yuji, Wakabayashi, Hiroki, Yamanaka, Keiichi
Format: Article
Language:English
Subjects:
adverse event
biologic
Bone surgery
Case reports
Cytokines
Dermatitis
Dermatology
Erythema
Growth factors
interleukin 6
Medicine
Monoclonal antibodies
Pain
Patients
Psoriasis
Rheumatoid arthritis
Single Case
tocilizumab
University graduates
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Summary: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.
ISSN:1662-6567
1662-6567
DOI:10.1159/000504429