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.

건선과 아토피피부염의 면역학적인 기전

한태영,이정민 대한건선학회 2023 대한건선학회지 Vol.20 No.1

Atopic dermatitis (AD) and psoriasis are inflammatory skin disorders that impose considerable burdens upon patient’s quality of life, health outcome, and work productivity. Atopic dermatitis involves erythematous patches that are not well demarcated and are often excoriated and associated with severe pruritus. Psoriasis presents with well-demarcated plaques covered with silvery white scales with variable levels of pruritus. Despite important clinical distinctions, the two disorders are similar in that epidermal keratinocytes respond to T-cell derived cytokines by altering growth and differentiation responses, accounting for major parts of the overall disease phenotype. Psoriasis is a disease largely driven by Th17 T-cells and associated IL-17 activation, while AD has a strong Th2 component associated with IL-4, IL-13 over-production, and both disorders have activation of Th22 T-cells and Th1 pathways with increased IL-22 and IFN-γ production. AD is a disease frequently associated with increased IgE production and overt allergies or asthma, most likely due to increased Th2 activation, which is largely lacking in psoriasis. In, this article, I will review and compare the immunopathogenesis of AD and psoriasis.

판상 건선과 인접해서 발생한 Bowen’s disease 1예

최훈,정병훈,나찬호,김민성,신봉석 대한건선학회 2023 대한건선학회지 Vol.20 No.1

A 57-year-old man presented with asymptomatic solitary 20X10 cm2 sized scaly erythematous plaque on his back for one year. He had a personal history of angina pectoris and psoriasis vulgaris. A skin biopsy showed hyperkeratosis, parakeratosis, and dense inflammatory cell infiltrations were observed at low magnification. Also, at high magnification, dyskeratotic cell and keratinocytes with hyperchromatic, pleomorphic, large nuclei, and atypical mitosis were observed in the epidermis. He was diagnosed with Bowen’s disease and is being treated with cryotherapy at 2-4 intervals. Herein we report a Bowen’s disease adjacent to psoriatic lesion in psoriasis patient.

New-onset Plaque Psoriasis Following COVID-19 Infection

유은희,Julius Garcia Gatmaitan,유승아,이지현 대한건선학회 2023 대한건선학회지 Vol.20 No.1

As COVID-19 spreads worldwide, cutaneous manifestations of Coronavirus 2019 (COVID-19) infections are increasing and there are only a few cases of new-onset psoriasis after COVID-19 infection worldwide. Herein, we report a case of new-onset plaque psoriasis in an Asian man following COVID-19 infection. A 67-year-old male presented to our clinic with pruritic erythematous scaly papules and plaques on both lower extremities as well as trunk after COVID-19 infection. He was finally diagnosed with plaque type psoriasis following skin biopsy, and treated with oral cyclosporine. Clinicians should be aware that new-onset plaque psoriasis may develop secondary to COVID-19 infection.

건선과 아토피피부염의 유전학

이상두,정기헌 대한건선학회 2023 대한건선학회지 Vol.20 No.1

Psoriasis and atopic dermatitis are common inflammatory skin diseases caused by the interplay between multiple genetic and environmental risk factors. Significantly higher incidence of the disease among relatives and higher concordance rate among monozygotic twins over dizygotic twins suggest the involvement of genetic factors. Although knowledge of the genetic background of atopic dermatitis and psoriasis is still incomplete, major advances have been made in the past few years, particularly through genome-wide association approaches. In psoriasis, more than 400 genes and their related SNPs are known to be associated with an increased risk of developing psoriasis. These include genes involved in antigen presentation (HLA-C, ERAP1), T17 cell activation (IL23R, IL23A, IL12B), Skin barrier function, NF-kB signaling, Type 1 interferon signaling. HLA association is confidently considered the most likely causal susceptibility allele for psoriasis, but not for atopic dermatitis. Loss-of-function mutations in FLG, encoding the skin barrier protein filaggrin, remain the strongest genetic risk factor identified for atopic dermatitis, but variants influencing immune system and extracellular matrix are also important. Shared genetic loci for both diseases have been reported. Genome-wide linkage scans have identified multiple loci linked to each disease and revealed overlap with psoriasis and atopic dermatitis susceptibility loci on chromosomes 1q21, 3q21, 17q25 and 20p12. Knowledge of the genetic factors leading to these diseases will lead to an understanding of their complex pathophysiology

Secukinumab 치료 실패 후 ixekizumab으로 성공적으로 치료된 판상 건선 1예

윤지상,김성준,배경남,손진화,신기혁,김훈수,고현창,김문범,김병수 대한건선학회 2021 대한건선학회지 Vol.18 No.2

If there is no improvement of the lesion despite the use of a biological agent, a change to another agent may be considered, and successful ‘intra-class switching’ has been reported. The reason for the effect of changes within the same class is explained as different depending on the molecular structure and pharmacokinetic characteristics of the drug. Pharmacokinetics may show differences in molecular affinity and half-life. Herein, we report a case of successful treatment with ixekizumab, the same IL-17A inhibitor class drug, after secukinumab treatment failure. The patient was diagnosed with psoriasis on histological examination, and treatment with secukinumab was started in November 2017. However, from the 5th month onwards, there was an insufficient response, and psoriasis worsened, and the treatment was judged as a failure and then stopped. Ixekizumab was started in December 2019, and almost all lesions have improved and remained stable thereafter.

소아 전신농포건선에 대한 사이클로스포린 치험 2예

성재용,김창용,조영아,유다애,이양원,최용범 대한건선학회 2023 대한건선학회지 Vol.20 No.1

Generalized pustular psoriasis (GPP) is a rare, life-threatening form of psoriasis characterized by widespread sterile pustules on erythematous skin and is even rarely found in children. Prompt diagnosis and treatment are necessary as GPP flare can be life-threatening. Due to its rarity, there are currently no treatment guidelines for childhood GPP in Korea. In this report, we present two cases of 8-year-old boys with childhood GPP who were successfully treated with cyclosporine. Both patients had extensive erythema with papulopustular lesions on the trunk and extremities. One patient had been treated with systemic corticosteroid in another clinic and showed resolution but eventually showed recurrence and flare. Another patient had intermittently tried low dose oral acitretin and topical steroid treatment in another clinic. We started treatment with cyclosporine for periods of 15 weeks and 10 weeks respectively, until their lesions showed clearance. Our cases suggest that cyclosporine is a safe and effective treatment option for acute GPP in children.

보통 건선 환자에서 병발된 수포성 유천포창 1예

김윤섭,김태근,박철종,이경호 대한건선학회 2023 대한건선학회지 Vol.20 No.1

Psoriasis is a chronic inflammatory skin disease with known various comorbidities including cardiovascular and metabolic diseases. Bullous pemphigoid is autoimmune bullous skin disease commonly diagnosed in elderly patients. Cases with psoriasis vulgaris with concomitant bullous pemphigoid were rarely reported. Herein, we present a case of 47-year-old Korean male diagnosed as psoriasis vulgaris with concomitant bullous pemphigoid. The patient presented with pruritic multiple scaly erythematous plaques and bullae on the whole body developed 5 days ago. The patient was diagnosed with psoriasis vulgaris 30 years ago. Based on the histopathological examination with direct immunofluorescence, diagnosis of psoriasis vulgaris with concomitant bullous pemphigoid was made. After treatment of narrowband ultraviolet B phototherapy and oral acitretin (20~60 mg) for 4 months, both psoriasis and bullous pemphigoid lesions showed improvement. We further reviewed relevant literatures regarding epidemiology, clinical findings, pathogenesis, and treatments in patients with psoriasis vulgaris and concomitant bullous pemphigoid.

만성신부전으로 혈액투석 중인 판상 건선 환자에서 발생한 저용량 Methotrexate 독성 1예

문수진,장윤경,김동현 대한건선학회 2023 대한건선학회지 Vol.20 No.1

Methotrexate is an effective treatment for psoriasis and psoriatic arthritis. However, as methotrexate is mainly eliminated by the kidneys, patients with chronic kidney disease may experience hematologic complications such as myelosuppression due to methotrexate toxicity. A 58-year-old male psoriasis patient with end-stage renal disease undergoing hemodialysis was treated with low-dose MTX (7.5 mg/week) and developed pancytopenia after 5 weeks of treatment. His serum MTX level was < 0.040 umol/L. While MTX toxicity typically occurs within 7~14 days, in this case, it occurred one month later. Despite the low levels of MTX in his blood, myelosuppression led to pancytopenia, which resulted in the development of pneumonia with Pseudomonas aeruginosa infection. Ultimately, this led to septic shock and the patient’s death. In conclusion, since low-dose MTX toxicity in CKD patients is challenging to predict, we should exercise extra caution.

건선 환자에서 발생한 간질성 폐질환 1예

김재윤,양나경,은윤수,이휘인,정의현,이성열,김정은 대한건선학회 2023 대한건선학회지 Vol.20 No.1

Patients with psoriasis may be accompanied by various systemic comorbidities, including lung diseases, and it is crucial to manage them. Interstitial lung disease is occasionally reported in patients with psoriasis secondary to the use of immunosuppressants in most cases. A 54-year-old woman, who had a history of psoriasis for 2 years but had never used immunosuppressant or biologics, presented with cough and dyspnea that started 6 months ago. She was diagnosed with interstitial lung disease on chest X-ray and chest CT, and oral steroid was used. The interstitial lung disease responded to oral steroid treatment for one year, but psoriasis lesions became worse after discontinuing oral steroids. She is currently being treated with narrowband ultraviolet B (NBUVB) therapy and calcipotriol/betamethasone topical gel. Herein, we report a rare case of interstitial lung disease in psoriasis patient.