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.

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.

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.

한국인 건선, 백반증, 피부암, 아토피피부염과 원형탈모 환자에서 혈중 비타민 D 농도

김종규,김용일,최훈,나찬호,김민성,신봉석 대한건선학회 2019 대한건선학회지 Vol.16 No.2

Introduction: Vitamin D has been shown to correlate with a variety of skin diseases including psoriasis, skin cancers and atopic dermatitis, because it is involved in innate and adaptive immunity. However, since most of the studies are conducted in the West countries, it is difficult to apply the results to Korean. Objective: To investigate the association between various dermatologic diseases and serum vitamin D levels in Korean. Methods: We retrospectively reviewed the serum levels of vitamin D in 206 patients who visited our clinic from November 2013 to February 2019 and diagnosed as psoriasis, vitiligo, skin cancers, atopic dermatitis and alopecia areata. The severity of psoriasis was assessed by Psoriasis Area Severity Index (PASI), and the vitamin D levels of 38 healthy controls without other disease were compared with those of psoriasis. Results: The average serum vitamin D level in patients was found to be 17.09 10.93 ng/mL and 152 (72.8%) patients had serum vitamin D levels below 20 ng/mL. Serum vitamin D levels were lowest in patients with atopic dermatitis (15.97 ng/mL). In psoriasis patients, there was no difference in serum vitamin D levels between healthy controls (p>0.05), and there was no association between PASI and serum vitamin D levels (p>0.05). Conclusion: It is necessary to pay attention to apply the results of the association between serum vitamin D levels and these dermatologic disease reported in foreign countries.

여성에서의 건선: 관리와 치료

허윤정,김정은 대한건선학회 2022 대한건선학회지 Vol.19 No.1

Psoriasis is a chronic inflammatory skin disease affecting 0.5~3% of the general population worldwide. About 50% of these patients are women and the majority of them have onset of disease before 40 years of age, coinciding with the reproductive years. The burden of psoriasis is particularly high for women in all domains of quality of life, which poses specific challenges for their treatment. However, well-established guidelines for the treatment of women of childbearing age are lacking. Because of immunomodulatory change in pregnancy, psoriasis activity often improves or stabilizes during pregnancy. But up to a quarter can experience disease worsening, and postpartum flares are common. Therefore, balancing the risk of treatment with the risk of uncontrolled disease is important. In this article, we review issues specific to treating women of childbearing age with psoriasis and recent guidelines for the treatment of psoriasis in women.

유방암 환자에서 항암치료 후 악화된 건선을 Ixekizumab으로 치료한 1례

이은혜,김준영,장용현,이원주,이석종,박경덕 대한건선학회 2020 대한건선학회지 Vol.17 No.2

A 48-year-old woman, who was experienced the aggravation of psoriasis after chemotherapy, visited our medical center. She was suffered from mild psoriasis for about 20 years and it was controlled using topical steroid and vitamin D agent. Six months ago, she was diagnosed with breast cancer and received preoperative chemotherapy with doxorubicin, cyclophosphamide, docetaxel, and trastuzumab, after which extensive pruritic erythematous papules and scaly plaques developed. She did not respond to conventional treatment including oral cyclosporine. She started ixekizumab to treat aggravated psoriasis. Most of the lesions appeared to be improved after 8 injections of ixekizumab, and trastuzumab with hormonal therapy are currently being used to control breast cancer. There is some debate regarding treatment with biologics in psoriasis patients with a history of cancer due to the burden of recurrence or progression of cancer. Herein, we report a case of treatment with ixekizumab for exacerbated psoriasis after chemotherapy.

COVID-19와 건선

장윤경,석승휘,김동현 대한건선학회 2020 대한건선학회지 Vol.17 No.1

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) virus, has been spreading worldwide since December 2019. Most of COVID-19 patients exhibit mild-to-moderate symptoms and recover without sequelae, however some patients progress to acute respiratory distress syndrome or multiple organ failure, associated with high mortality. Psoriasis is chronic inflammatory disease represented by innate and adaptive immune dysregulation, which is targeted by immunomodulatory therapies. There is uncertainty concerning the outcome of COVID-19 infection in psoriasis patients who are receiving conventional immunosuppressive medications or biologic therapies. In this review, we will discuss about what dermatologists need to aware of and what we can help patients as dermatologists.

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.

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.