건선 환자에서 Guselkumab 치료 중 발생한 후두암

최고운,김동현 대한건선학회 2021 대한건선학회지 Vol.18 No.2

Although biologics are highly effective in psoriasis, they have significant effects on innate and adaptive immune systems that may negatively impact on mechanisms of cancer immunosurveillance. However, there are limited data on the risk of cancer in psoriasis patients treated with biologics. A 70 years-old male patient presented with plaque psoriasis for four years’ duration. After receiving methotrexate for nine months, guselkumab was started due to inefficacy. After two years of guselkumab therapy, he visited the otolaryngologist with the voice change and pain around the left jaw for one year. The result of laryngoscopic biopsy showed a left supraglottic squamous cell carcinoma, and there was no metastasis on additional imaging studies. He was transferred to another hospital for surgery and concurrent chemoradiation therapy, and continues guselkumab treatment. Herein, we report on a case of laryngeal cancer during guselkumab treatment in a patient with psoriasis with the review of literatures.

한국인 노인 건선환자의 임상적 특징에 대한 후향적 단일기관 연구

김우일,배경남,김훈수,고현창,김문범,김병수 대한건선학회 2019 대한건선학회지 Vol.16 No.2

Background: Psoriasis of the elderly is not rare and also has a chronic relapsing course, and affects quality of life. However, there has been a paucity of data regarding the clinical features of psoriasis in the elderly. Objectives: The purpose of this study was to investigate clinical features of psoriasis in the elderly. Methods: We retrospectively reviewed medical records and clinical photos of psoriasis in the elderly (≥65 years) visiting department of dermatology at Pusan National University from January 2014 to December 2017. A total of 83 patients who aged 65 or older with psoriasis were included (elderly group), and we furtherly analyzed clinico-epidemiological, and therapeutic aspects comparing with patients who aged under 65 years (non-elderly group) with psoriasis visiting same period. Results: The Mean age of the elderly and non-elderly group was 72.8 and 37.7 years old. The ratio of male to female patients was significantly higher in the elderly group (1.63:1, 1:1, respectively). The mean PASI score had no statistical difference between two groups (5.9±4.03, 6.4±5, respectively). Pruritus, obesity, metabolic syndrome and psoriatic arthritis were statistically more frequent in the elderly group. Systemic agents were more frequently prescribed to the elderly group than non-elderly group during the treatment. Conclusion: This study shows various clinical features of psoriasis in the elderly. Our data would be helpful for dermatologists managing the elderly with psoriasis.

건선 환자에서 생물학적제제 사용 전까지의 전신치료제와 광선치료 사 용 경향에 대한 분석: 국민건강보험공단 자료 분석

오재홍,박희재,박혜진 대한건선학회 2019 대한건선학회지 Vol.16 No.2

Background: The use of biologics to treat psoriasis has been increased dramatically. A considerable disease period often precedes the initiation of biologics and patients are treated with variable modalities during this period. However, there is a lack of nationwide studies examining treatment patterns before starting biologics. Objective: We investigated treatment patterns until the initiation of biologics in psoriasis patients. Methods: We conducted a retrospective cohort study using the National Health Insurance System Claims Database of Korean from January 1, 2008 to December 31, 2017, including psoriasis patients who were naïve to biologic agents [ustekinumab (UST), TNF-α inhibitor (TNFi): adalimumab, etanercept, infliximab]. We analyzed the systemic agents (acitretin, cyclosporine, methotrexate) and phototherapy prescription patterns until the initiation of biologics. Results: Among 527 patients, 6.1% (n=32) had psoriatic arthritis [UST: n=9(3.3%), TNFi: n=23(9.1%)]. In UST users (n=295), cyclosporine was prescribed more than methotrexate(76.4%, 41.3% in ever users, p<0.05), while in TNFi users (n=252), methotrexate was prescribed more than cyclosporine (77.4%, 48.4% in ever users, p<0.05). Medication patterns were as follows: monotherapy (50.5%), dual-therapy (32.6%), and triple-therapy (16.9%). TNFi users had higher median cumulative dose (0.33g) and longer duration (31 weeks) of methotrexate than UST users (0.17g, 19 weeks). The cumulative doses of methotrexate were as follows: <1 g (88.4%), 1~2g (8.5%), 2~3g (2.1%), and ≥3 g (0.9%). The durations of cyclosporine were as follows: <6 months (52.5%), 6~12 months (22.9%), 1~2 years (13.7%) and ≥2 years (10.8%). Ninety-two patients (17.5%) underwent phototherapy and all of them had used systemic agents. The median duration of total treatment including systemic agents and phototherapy before starting biologics was 41.5 weeks. Conclusion: Most were treated with appropriate doses and durations of systemic agents and phototherapy, but some were treated with more than those of recommended guidelines. There is no consensus about the appropriate treatment duration before starting biologics. Therefore, it is needed to consider the proper transition period for the severe patients who require rapid disease control.

건선의 생물학제제 교체치료

윤상웅 대한건선학회 2018 대한건선학회지 Vol.15 No.1

Not every psoriasis patient who prescribed biologics for psoriasis shows clinical improvement defined by Psoriasis Area and Severity Index (PASI) 75. Clinicians should consider the switching of one biologic to different one to improve patient’s psoriasis. We can meet two clinical situations as initial non-responder and loss of effectiveness after long term use. Initial non-responder shows less than 75% improvement of PASI at primary endpoint. It is better to consider to use biologics of different mechanism of action. Loss of effectiveness after long term use includes biologics fatigue. The other biologics than previously used one can be considered for this patient. Biologic fatigue phenomenon is commonly developed when we use biologic for long term period, we do not know the exact character and its proper role in the loss of effectiveness. Recently, newer biologics are coming and will be in market competitively, clinicians will have good tools to cope with biologics failure patients.

건선환자에서 발생한 균상식육종 1예

박근휘,하대룡,손진화,이정수,신기혁,김훈수,고현창,김문범,김병수 대한건선학회 2020 대한건선학회지 Vol.17 No.1

There has been increasing awareness of the association between psoriasis and lymphoma. There is a hypothesis that the evolution of psoriasis into cutaneous T-cell lymphoma is the result of chronic immune stimulation and lymphoproliferation. Moreover, misdiagnosis and/or therapies including immunosuppressant, and immunomodulating agents may explain the high risk of developing lymphoma in psoriatic patients. We report a 48-year-old woman with a 25-year history of psoriasis. She had been diagnosed as psoriasis with typical histopathological features. Although the therapeutic response to cyclosporine and methotrexate was good at the early stage of psoriasis, the clinical manifestation of mycosis fungoides (MF) were observed as the symptoms worsened. After repetitive skin biopsies, epidermotropism of atypical lymphocytic cells were observed, and monoclonality was detected in the TCR gene rearrangement. Neither internal organ involvement nor lymphadenopathy was detected by computed tomography and bone marrow biopsy. The patient was diagnosis with MF as T4N0M0B0 in TNMB staging.

노령층에서의 건선: 특징과 치료

손승진,성연국,정경은 대한건선학회 2022 대한건선학회지 Vol.19 No.2

Psoriasis is a chronic inflammatory skin disease. Metabolic syndrome and cardiovascular disease, such as hypertension, stroke, diabetes mellitus, and hyperlipidemia, are more frequent among psoriatic patients and they experience increased morbidity and mortality than the normal population. Therefore, psoriasis and its comorbidities are important issues, especially in the geriatric population. However, little is known about psoriasis in geriatric patients, whereas treating this growing population can be challenging due to comorbidities, polypharmacy and physical impairments. Also, it will be of increasing importance to focus on the holistic management of geriatric dermatological conditions as this approach is potentially more cost effective because treatment is individualized and takes into account the patient’s overall medical and social circumstances. Treatment goals should be kept simple and individualized for each patient, based on concomitant comorbidities, potential adverse effects, existing quality of life, self-care capability, drug history, care-giver situation, financial needs, feasibility for follow- up and patient’s preferences. Here, we review the characteristics of geriatric patients with psoriasis and discuss rational treatment strategies.

Ixekizumab으로 성공적으로 치료된 포도막염과 건선관절염을 동반한 판상 건선 1예

김종규,정병훈,최훈,나찬호,김민성,신봉석 대한건선학회 2022 대한건선학회지 Vol.19 No.1

A 54-year-old woman presented with pruritic multiple scaly erythematous plaques on whole for one decade. Physical examination revealed scaly erythematous plaques on whole body, nail pittings on her fingernails, and tenderness with swelling on her fingers and ankles. Based on clinical criteria, she was diagnosed psoriasis and psoriatic arthritis. She was treated with methotrexate and sulfasalazine for over 1 year, but symptoms didn’t improved. Also she decreased visual acuity in left eye and diagnosed with uveitis as a result of ophthalmologic evaluation. Her symptoms didn’t improve despite continued medications, so we decided to administer ixekizumab. After Ixekizumab administration, her symptoms had been improved. Psoriasis is a chronic, inflammatory disease characterized by scaly plaques. Uveitis is an intraocular inflammatory disease with many causes. Treatment of uveitis is corticosteroid, immunosuppressive agents and biologics. We conclude that ixekizumab can be considered as a treatment option for psoriasis patients with psoriatic arthritis and uveitis.

만성신부전이 동반된 판상건선 환자의 생물학적제제 치료 3예

장윤경,김동현 대한건선학회 2021 대한건선학회지 Vol.18 No.1

Psoriasis has been associated with various cardiovascular and metabolic comorbidities. Recently, there are studies reporting the association of psoriasis with renal diseases. However, there is little information on the safety and efficacy of biologic therapies used in psoriasis patients with renal failure. A 35-year-old man presented with psoriasis and chronic kidney disease (CKD) undergoing hemodialysis. Narrowband ultraviolet B (NBUVB) therapy was unsatisfactory. After treatment with guselkumab, psoriasis area and severity index (PASI) score decreased from 11 to 1.2 after 12 weeks. A 52- year old-man and a 39-year-old woman presented with psoriasis and CKD. Treatment with NBUVB and methotrexate did not meet the treatment goal. After treatment with ixekizumab, PASI score decreased from 11 to 2 and 12 to 1.4 after 12 weeks, respectively. All of them have maintained good clinical responses without side effects. Herein, we report successful cases of using guselkumab and ixekizumab to treat psoriasis patients with renal failure suggesting guselkumab and ixekizumab as safe treatment options.

생물학 제제 치료 중인 한국인 건선 환자에서 Interferon-gamma Release Assay 추적검사결과에 대한 연구

김성민,성재용,김창용,조영아,유다애,이양원,최용범 대한건선학회 2022 대한건선학회지 Vol.19 No.1

Background: Biologics are widely used for the treatment of moderate to severe psoriasis as their safety and efficacy have been determined. However, as biologics act as antagonists of Interleukin (IL) or Tumor necrosis factor-alpha (TNF-α), there are concerns regarding immunity to infectious diseases including tuberculosis (Tb). Objectives: We analyzed the serial interferon-gamma release assay (IGRA) for detecting latent tuberculosis infection in patients treated with biologics (ustekinumab, secukinumab, guselkumab, ixekizumab) for psoriasis. Methods: A retrospective analysis of IGRA results was performed during follow-up sessions of patients with psoriasis between January 2013 and March 2022. Results: Among the total 122 patients, the initial IGRA results of 78 patients (63.9%) were negative and 44 patients (36.1%) were positive for Tb. During the 9 years of follow up, 3 patients (3.8%) of the 78 who were initially IGRA negative showed seroconversion and tested IGRA positive; 10 patients (22.7%) of the 44 patients who were initially IGRA positive showed seroreversion and tested IGRA negative. Of the three patients with seroconversion, none had active tuberculosis infection. Conclusion: Seroconversion was observed in three patients treated by biologics in this study. Considering the epidemiologic characteristics of Korea having a high incidence rate of tuberculosis, annual follow-up examination along with preventive tuberculosis treatment is necessary.

건선 연구에서 건선 피부 모델의 역할

정인재,김동현,이희정 대한건선학회 2018 대한건선학회지 Vol.15 No.1

Psoriasis is a common immune-mediated chronic inflammatory skin disease. Several cytokines involved in the immunological mechanism of psoriasis have now been identified. Known cytokines are entangled to form a large signaling pathways are currently being studied to find cytokines that play the most important role in pathogenesis. Psoriasis signaling mechanisms have been known through various studies using cells, mouse models, and psoriasis skin models. The psoriasis skin model is an important tool for psoriasis studies. This review summarizes the psoriasis skin model currently in use.