Open AccessPsoriasiform Dermatitis Developing during Treatment of Juvenile Idiopathic Arthritis with Tocilizumab
Author(s) -
Matsushima Yoshiaki,
Hayashi Akinobu,
Mizutani Kento,
Kondo Makoto,
Nakai Yasuo,
Habe Koji,
Yamaguchi Yukie,
Kozuka Yuji,
Wakabayashi Hiroki,
Yamanaka Keiichi
Publication year - 2019
Publication title -
case reports in dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.338
H-Index - 18
ISSN - 1662-6567
DOI - 10.1159/000504429
Subject(s) - single case
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.