Skin Therapy Letter HOME
Written for dermatologists by dermatologists. Indexed by the US National Library of Medicine.
Skin Information
NETWORK
Skin Therapy Letter About STL Subscribe Today SkinCareGuide Network Site Map
CUSTOM DERMATOLOGY SEARCH:
Loading

Derm News: 2007.9(1)

Eruptive papules during efalizumab (anti-CD11a) therapy of psoriasis vulgaris: a case series

BMC Dermatology 2007;7:2 (Published 26 February 2007)
Michelle A Lowes, Francesca Chamian, Maria V Abello, Craig Leonardi, Wolfgang Dummer, Kim Papp and James G Krueger
ABSTRACT

Background

Newer biological therapies for moderate-to-severe psoriasis are being used more frequently, but unexpected effects may occur.

Objectives

We present a group of 15 patients who developed inflammatory papules while on efalizumab therapy (Raptiva, Genentech Inc, anti-CD11a). Immunohistochemistry showed that there were increased CD11b+, CD11c+ and iNOS+ cells (myeloid leukocytes) in the papules, with relatively few CD3+ T cells. While efalizumab caused a decreased expression of CD11a on T cells, other circulating leukocytes from patients receiving this therapy often showed increased CD11b and CD11c. In the setting of an additional stimulus such as skin trauma, this may predispose to increased trafficking into the skin using these alternative 2 integrins. In addition, there may be impaired immune synapse formation, limiting the development of these lesions to small papules. There is little evidence for these papular lesions being "allergic" in nature as there are few eosinophils on biopsy, and they respond to minimal or no therapy even if efalizumab is continued.

Conclusions

We hypothesize that these papules may represent a unique type of "mechanistic" inflammatory reaction, seen only in the context of drug-induced CD11a blockade, and not during the natural disease process.


    Back to Current Volume:   Dermatology News 2007.9


The Derm News service provided by the Editorial Consultants of Skin Therapy Letter© and its founding editor Dr. Stuart Maddin.