Table 1.
Implicated biologics, timing of onset and management of patients with paradoxical eczema.
| Patient | Age, years | Sex | Biologic(s) (onset after biologic, days a ) | Management and treatment response |
|---|---|---|---|---|
| 1 | 27 F | F | ADA (60); UST (NR) | Topicals. Improved on stopping ADA. Recurred on UST and persists on GUS |
| 2 | 49 F | F | UST (271) | Topicals. UST continued. PE persists |
| 3 | 51 M | M | ADA (109); UST (1597); GUS (112) | Topicals and ADA/UST stopped; PE resolved. Recurred on GUS; controlled with topicals |
| 4 | 34 M | M | UST (81); INF (13); SEC (55); GUS (42) | UST, INF and SEC stopped; no resolution of PE. Partial improvement with ciclosporin and MTX. Apremilast ineffective for PE. Tofacitinib controlled PE but not psoriasis. PE persists on GUS |
| 5 | 61 M | M | UST (238); SEC (42); GUS (25) | Stopped UST and started ciclosporin; PE resolved. Stopped SEC; ciclosporin resolved PE. GUS continued; PE controlled with topicals |
| 6 | 66 M | M | IXE (85) | Topicals. IXE continued. Partial control of PE |
| 7 | 45 F | F | IXE (206) | Topicals; IXE switched to GUS. PE resolved |
| 8 | 43 M | M | ETA (5) | Topicals. Continued ETA. PE resolved |
| 9 | 54 M | M | UST (1056) | None. PE resolved |
| 10 | 67 M | M | UST (804) | Topicals. PE resolved |
| 11 | 63 F | F | ADA (331) | None. PE resolved |
| 12 | 39 F | F | ADA (959) | ADA stopped. PE resolved; psoriasis stable off biologic |
| 13 | 55 M | M | ADA (782); ADA (28) | ADA paused while investigated for breathlessness; PE resolved then recurred on restarting ADA. Controlled with topicals |
| 14 | 35 M | M | UST (91) | Topicals. UST continued. Ongoing PE flares |
| 15 | 52 F | F | ADA (977) | None. Outcome NR |
| 16 | 26 F | F | ADA (252); SEC (149) | MTX for 4 months. PE improved. ADA switched to SEC; PE controlled on SEC with topicals |
| 17 | 63 M | M | ADA (28) | Admission for topical treatments. ADA continued. PE resolved |
| 18 | 46 F | F | ADA (47); SEC (354) | Topicals and ciclosporin; PE improved. Recurred on SEC, PE resolved after admission and topical |
| 19 | 44 M | M | UST (40) | Topicals. UST continued. PE resolved |
| 20 | 61 M | M | ADA (642); IXE (161) | Topicals and MTX; PE persisted, switched to UST. Switched to IXE due to poor psoriasis control; PE controlled with topicals |
| 21 | 31 M | M | IXE (494) | Topicals and ciclosporin; PE improved then recurred. Switched to BRO; PE resolved |
| 22 | 36 F | F | ADA (62) | Topicals and ciclosporin; PE improved, but PE and psoriasis flare on tapering ciclosporin. Planned switch to IXE |
| 23 | 56 F | F | IXE (11); UST (7) | IXE stopped; ciclosporin; apremilast; prednisolone. PE improved on prednisolone. Switched to UST, which resulted in recurrence of PE; resolved with admission for topical treatments |
ADA, adalimumab; BRO, brodalumab; GUS, guselkumab; INF, infliximab; IXE, ixekizumab; MTX, methotrexate; NR, not reported; PE, paradoxical eczema; SEC, secukinumab; UST, ustekinumab.
a
For patients with > 1 episode, age at onset of first episode is recorded.