Jeffrey Zhu Hu1, Steven D Billings2, Di Yan3, Anthony Patrick Fernandez4. 1. Case Western Reserve University School of Medicine, Cleveland, Ohio. 2. Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, Ohio. 3. The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York. 4. Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, Ohio. Electronic address: fernana6@ccf.org.
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.
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.
Authors: R Stalder; N Brembilla; C Conrad; N Yawalkar; A Navarini; W H Boehncke; G Kaya Journal: Clin Exp Dermatol Date: 2021-12-17 Impact factor: 4.481